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DIET  LISTS 

OF  THE 

PRESBYTERIAN   HOSPITAL 

NEW  YORK  CITY 


COMPILED,  WITH  NOTES,  BY 

HERBERT  S.    CARTER,  A.  M.,    M.  D. 

COKSULTING  PHYSICIAN  TO  THE  LINCOLN  HOSPITAL;  ASSOCIATE  IN  CLINICAL 
MEDICINE  AT  COLCMBLA  UNIVERSITY,  AND  ASSOCIATE  VISITING  PHYSI- 
CIAN   TO    THE    PRESBYTERIAN    HOSPITAL,    NEW    YORK    CITY 


SECOND  EDITION,  THOROUGHLY  REVISED 


Philadelphia  and  London 

W.  B.   SAUNDERS   COMPANY 
1919 


Copyright,  igis,  by  W.  B.  Saunders  Company.    Reprinted  December,  igij, 

January,  igis,  and  May,  1916.    Revised,  reprinted,  and 

recopyrighted  January,  1919 


Copyright,  1919,  by  W.  B.  Saunders  Company 


PRINTEO    IN    AMERICA 

PRESS    OF 
B.     8AUN0ERS     COMPANY 
PHILADELPHIA 


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PREFACE  TO  THE  SECOND  EDITION 


In  presenting  the  second  edition  of  this  Kttle  diet 
book,  an  attempt  has  been  made  to  include  new  mate- 
rial where  necessary,  and  to  rewrite  certain  portions 
in  the  light  of  present-day  knowledge  and  usage.  The 
subject  of  diet  in  diabetes  has  undergone  a  marked 
change,  with  the  introduction  of  Allen's  method,  and 
there  is  included  here  the  principles  and  practice  of 
this  plan  of  dietary  control  of  diabeteg,  as  modified 
by  Geyelin  and  used  in  the  Presbyterian  Hospital. 
Advantage  has  been  taken  of  the  kindly  criticism  of 
the  first  edition  to  make  some  sections  more  complete, 
and  to  cut  down  others.  It  is  encouraging  to  note 
the  great  interest  in  the  efficacy  of  diet  in  certain  con- 
ditions shown  by  the  general  practitioner,  as  physical 
means  of  treating  disease  are  assuming  a  larger  place 
in  the  practice  of  medicine,  where  formerly  reliance 
was  placed  on  drugs.  This  is  in  hne,  of  course,  with 
the  modern  concept  of  medicine  which  has  for  its  object 
the  correlation  of  etiology  and  rational  treatment.  The 
author  wishes  to  express  his  indebtedness  to  his  col- 
leagues, Dr.  Rawle  Geyelin  for  the  use  of  certain  diets 
for  diabetes.  Dr.  D.  W.  Atchley  for  salt-poor  diets. 
No.  3,  4,  and  5  and  one  of  the  cardiac  diets.  Dr.  A. 
V.  S.  Lambert  for  the  diet  used  after  gastro-enteros- 
tomy,  Dr.  Allen  Whipple  for  the  gastric  tolerance  diet, 

9 


lO  PREFACE 

Dr.  George  R.  Lockwood  for  his  modification  of  the 
von  Leube  diet,  Dr.  Warren  Coleman  for  the  modi- 
fied milk  typhoid  diets,  and  Dr.  W.  W.  Palmer  for 
his  criticism  and  helpful  suggestions  in  the  preparation 
of  this  new  edition. 

Herbert  S.  Carter. 
New  York  City, 
January,  1919. 


PREFACE  TO  THE  FIRST  EDITION 


The  Diet  Lists  contained  in  this  volume  have  been 
prepared  primarily  for  use  in  the  Presbyterian  Hospital; 
subsequently  the  comments  on  the  different  diets  were 
added,  for  while  the  indications  for  the  use  of  most  of 
the  diets  are  self-evident,  the  explanatory  notes  add  to 
the  completeness  of  the  presentation  and  may  be  found 
useful  to  some  readers.  The  Table  of  Standard  Por- 
tions was  prepared  originally  by  Prof.  Irving  Fisher,  of 
Yale  University,  through  whose  courtesy  I  am  allowed 
to  use  the  first  part  of  it,  while  the  actual  amounts  of 
Protein,  Carbohydrate,  and  Fat  contained  in  each  por- 
tion was  worked  out  from  Bulletin  No.  28. 

The  Table  of  Food  Values  has  been  taken  from  Bulle- 
tin 28,  1906,  of  the  Department  of  Agriculture,  Atwater 
and  Bryant. 

The  author  wishes  to  express  his  hearty  appreciation 
for  the  assistance  and  advice  given  him  in  the  prepara- 
tion of  this  book  by  Professor  Theodore  C.  Janeway,  also 
for  permission  to  use  certain  diet  Usts  prepared  by  him; 
to  Dr.  James  C.  Greenway,  for  his  courtesy  in  placing 

at  the  author's  disposal  the  diet  lists  of  the  New  York 

II 


12  PREFACE  TO  THE  FIRST  EDITION 

Hospital;  and  to  Dr.  Herman  0.  Mosenthal,  for  some 
of  the  diet  Ksts  used  in  the  Vanderbilt  Clinic,  from 
which  great  assistance  was  derived.  The  author  also 
wishes  to  express  his  appreciation  to  Miss  Sehna  Granat, 
for  the  chemical  analyses  of  some  of  the  diets  which 
were  made  by  her  in  the  laboratory  of  the  Presbyterian 
Hospital. 

When  diets  have  been  quoted  in  toto,  due  reference 
is  made  to  the  source  of  information.  The  idea  of  the 
table  of  carbohydrate  equivalents  was  obtained  from 
Von  Noorden's  writings,  but  adapted  to  an  American 
dietary  by  the  author. 

Herbert  S.  Carter. 
New  York  City. 


CONTENTS 


Pagb 

Introduction 17 

Regular  House  Diet — Convalescent  Diet — Soft  Diet  ...  21 

Regular  House  Diet 21 

Convalescent  Diet 24 

Soft  Diet 27 

Milk  Diet 27 

Liquid  Diet 27 

CJomments  on  Regular  House,  Convalescent,  Soft,  Milk  and 

Liquid  Diets 27 

TypHoiD  Diets 30 

Typhoid  Fluid  Diet  (No.  I ) 30 

Typhoid  Fluid  Diet  (No.  2) 31 

Typhoid  Diet  without  Milk 32 

Modified  Milk  Fluid  Diets 33 

Typhoid  Soft  Diet 35 

Comments  on  Typhoid  Fever  Diets 36 

Pneumonia  Diet 39 

Comments  on  Pneumonia  Diet. 40 

Nephritic  Diets 41 

Salt-poor  Diet  (No.  i) 41 

Salt-poor  Diet  (No.  2) 42 

Salt-poor  Diet  (No.  3) 43 

Salt-poor  Diet  (No.  4) 44 

Salt-poor  Diet  (No.  5) 45 

Schlayer's  Nephritic  Test  Diet 47 

Comments  on  Salt-poor  Diets 50 

Diet  in  Arteriosclerosis  and  Hypertension 52 

Karell  Treatment  for  Anasarca 53 

Comments  on  Cardiac  Diets 54 

Gastric  Diets 56 

Lenhartz  Diet  for  Peptic  Ulcer $6 

von  Leube  Treatment  for  Peptic  Ulcer 60 

Sippy's  Treatment  for  Peptic  Ulcer 62 

13 


14  CONTENTS 

Page 
Gastric  Diets  (Continued) 

Modified  Diet  for  Peptic  Ulcer 64 

Diet  for  Ambulatory  Cases  of  Peptic  Ulcer 66 

Duodenal  Feeding 67 

Gastro-enterostomy  Diet 69 

Gastric  Intolerance  Diet 70 

Gastric  HjTieracidity  Diet 71 

Convalescent  Gastric  Diet  (No.  i) 72 

Convalescent  Gastric  Diet  (No.  2) 73 

Comments  on  Gastric  Diets 74 

Gastric  Test  Meals 77 

Serial  Test  Meal 77 

Comment  on  Gastric  Test  Meals 78 

Diets  for  Intestinal  Conditions 81 

Anticonstipation  Diet  (No.  i)  (Hospital) 81 

Anticonstipation  Diet  (No.  2) 82 

Comments  on  Anticonstipation  Diets 83 

Diet  in  Intestinal  Auto-intoxication  and  Indicanuria  (No.  1) .  83 

Diet  in  Intestinal  Auto-intoxication  and  Indicanuria  (No.  2) .  84 

Comment  on  Diet  in  Intestinal  Auto-intoxication 85 

Diarrhea 86 

'Acute  Diarrhea 86 

Chronic  Diarrhea 86 

Constipating  Diet 88 

Schmidt's  Intestinal  Test  Diet 89 

Comments  on  Schmidt's  Intestinal  Test  Diet 91 

Diabetic  Diets 92 

Diet  for  a  Fast  Day 92 

Standard  Strict  Diet 93 

Alternate  Standard  Strict  Diet 94 

Sample  Diabetic  Diets 96 

Carbohydrate  Content  of  Foods 98 

Comments  on  Diabetic  Diets 99 

Joslin's  Resume  of  Allen's  Treatment  for  Diabetes     .    .    .    .103 

Pxtrin-free  Diets 108 

Liquid  Purin-free  Diet  (Folin) 108 

Soft  Purin-free  Diet 108 

Diet  in  Gout 109 

Purin-free  Articles  of  Diet no 

The  Purin  Bodies  in  Various  Food  Stuffs in 

Comments  on  Purin-free  Diets 113 


CONTENTS  15 

Pagb 

Obesity  Diets 115 

Comments  on  Obesity  Diets. ii6 

Five  Thousand  Calorie  Diet 119 

Comment  on  Five  Thousand  Calorie  Diet 120 

Low  Calcium  Diet 120 

Fixed  Nitrogen,  Calcium  and  Magnesium  Diet 131 

Comments  on  Low  Calcium  Diet 121 

Convalescent  Children's  Diets 122 

Regular  Children's  Diet  (2-5  years) 122 

Special    Children's    Diet    (Convalescing    from    Diarrheal 

Diseases) 123 

Special  Diabetic  Recipes 125 

Diabetic  Bread  and  Biscuits 125 

Diabetic  Milk  (Wright's) 125 

Analysis  of  Wright's  Diabetic  Milk 126 

Miscellaneous  Recipes 127 

Bran  Biscuits 127 

Bran  Crackers 127 

Cream  of  Pea  Soup 127 

Black  Bean  Soup 128 

Lactose  Jelly 128 

Artificial  Buttermilk 129 

Protein  Milk  (Eiweissmilch) 129 

Keller's  Malt  Soup 130 

Lactose  Ice  Cream 130 

Martin's  Milk 131 

Delafield's  Milk  Mixture 131 

Comments  on  Miscellaneous  Recipes 131 

Average  Weights  FOR  Men  and  Women 133 

Average  Chemical  Composition  of  American  Foods 134 

(Abstracted  from  Atwater  and  Bryant,  U.  S.  Dept.  of  Agri- 
culture, Bulletin  28.) 

Standard  Portions 147 

List  of  Foods,  Their  Composition  and  Caloric  Value    .   .   .154 

Index 159 


DIET  LISTS 

OF   THE 

PRESBYTERIAN  HOSPITAL. 
NEW  YORK  CITY 


INTRODUCTION 


Without  attempting  to  contribute  anything  new  to 
the  science  of  dietetics,  for  which  the  reader  is  referred 
to  any  one  of  the  many  excellent  works  on  this  subject, 
the  author  of  the  present  little  volume  has  in  mind 
merely  the  presentation  of  certain  diets  and  the  prin- 
ciples governing  their  use  from  a  purely  clinical  point 
of  view.  Although  accuracy,  approximately  considered, 
and  not  exhaustiveness  is  aimed  at,  it  is  hoped  that  the 
completeness  of  the  text  will  be  sufficient  for  the  pur- 
pose intended. 

There  is  a  constantly  growing  desire  on  the  part 
of  medical  men  to  utilize  more  exactly  the  therapeutic 
effect  of  foods,  but  many  are  deterred  by  the  seeming 
difficulty  of  the  subject,  and  by  the  lack  of  the  time 
necessary  to  prescribe  an  accurate  diet  list  suited  to 
one  of  the  many  varieties  of  disease.  In  addition, 
2  17 


1 8  INTRODUCTION 

institutions  in  which  one  would  expect  to  find  an  econ- 
omy in  dietetic  therapeutics,  as  well  as  accurate  methods 
for  arriving  at  desired  results,  are,  for  the  most  part, 
sadly  lacking  in  the  ability  to  give  their  inmates  the 
benefit  of  a  well-balanced  ration  and  their  board  of 
managers  an  economic  use  of  food  stuffs.  Hospitals 
and  asylums  of  all  sorts  should  find  an  easy  and  rational 
way  to  arrive  at  a  satisfactory  use  of  food  products. 

The  needs  of  an  individual  who  is  laid  up  by  a  broken 
leg  and  one  convalescing  from  an  acute  or  wasting  in- 
fectious disease  are  quite  different,  yet  many  hospitals 
have  one  standard  diet  for  all  such  cases,  nor  is  allow- 
ance made  for  the  different  requirements  of  men  and 
women  based  on  the  caloric  needs  of  the  body  per  kilo 
of  body  weight. 

In  the  diets  here  presented  advantage  has  been  taken 
of  the  facts  developed  by  Professor  Chittenden's  experi- 
ments, that  physiologic  economy  in  nutrition  can  be 
maintained  on  a  low  level  of  protein,  but  no  attempt 
has  been  made  to  keep  to  such  a  low  standard,  as  this  is 
obtained  best  by  a  gradual  process  of  reduction  in  the 
protein,  whereas  patients  in  general  are  used  to  much 
larger  amounts,  and  convalescents  are  in  need  of  a  cer- 
tain extra  quantity  of  protein  to  make  up  the  loss  due 
to  the  destructive  katabolism  from  acute  disease.  A 
rational  mean  has  been  aimed  at  in  the  quantity  of 
protein  recommended  which  will  allow  a  sufficient 
margin  of  safety  and  still  be  considerably  below  the 


INTRODUCTION  1 9 

old  standards  of  supposed  protein  requirement.  The 
advantages  to  the  individual  and  to  the  exchequer  of 
the  institution  in  this  are  obvious,  when  one  con- 
siders the  high  cost  of  practically  all  forms  of  protein 
food. 

In  determining  the  number  of  heat  units  for  men 
and  women,  an  average  weight  of  70  kilos  (154  pounds) 
has  been  assumed  for  men  and  60  kilos  (132  pounds) 
has  been  assumed  for  women  as  the  basis  of  reckoning, 
allowing  30  to  32  calories  per  kilo  of  body  weight, 
which  is  ample  for  an  individual  at  rest  or  light  work. 
This  applies  to  the  regular  house  diet,  soft,  gouty,  and 
anticonstipation  diets.  In  the  convalescent  diet  a 
greater  allowance  is  made,  of  approximately  35  calories 
per  kilo  of  body  weight.  No  hard-and-fast  line  has  been 
drawn  between  the  requirements  of  men  and  women 
requiring  purin-free,  low-calcium,  or  salt-poor  diets,  as 
the  cases  requiring  these  diets  are  never  numerous  in  a 
hospital  ward. 

The  caloric  value  of  the  primal  food  constituents  may 
be  stated  as  follows  (Reubner) : 

Calories 

I  gm.  protein 4.1 

1  gm.  fat 9.3 

I  gm.  carbohydrate 4.1 

I  gm.  alcohol 7.0 

The  caloric  needs  of  the  body  under  varying  condi- 
tions have  been  variously  estimated,  but  the  following 


20  INTRODUCTION 

represents  the  average  per  kilo  of  body  weight  for  a  man 
weighing  70  kilos  (Von  Noorden) : 

Calories 
Patient  in  bed,  30  calories  per  kilo.  ,  .   2100. 
Confined  to  room,  32  to  35  calories  per 

kilo 2240-2450 

Light  exercise,  35  to  40  calories  per  kilo  2450-2800 
Moderate  exercise,  40  to  45  calories  per 

kilo 2800-3150 

Very  heavy  labor,  45  to  60  calories  per 

kilo 3150-4200 


REGULAR  HOUSE  DIET— CONVALESCENT  DIET- 
SOFT  DIET 

Regular  House  Diet* 

Each  Day  of  the  Week 

Total  quantity  of  milk  allowed,  not  over  750  c.c. 
{i}i  pints). 

Breakfast. 

Coffee  or  tea  with  milk  and  sugar,  or  milk. 

Bread  and  butter. 

Two  eggs  to  each  patient  in  male  wards. 

One  egg  to  each  patient  in  female  wards. 

Cereal    with    milk    and    sugar. 

Fresh  fish.  Hash. 

Dinner. 

Soup. 
Meat  or  fish. 
Potatoes  (baked,  boiled,  or  mashed)  and  one  of  the  fol- 
lowing vegetables:  spinach,  squash,  boiled  onions, 
beets,  sweet  potatoes,  macaroni,  tomatoes,  corn. 
Bread  and  butter. 
Milk,  180  c.c.  (6  oz.). 
Pudding  or  fruit. 

*  Modified  from  New  York  Hospital  diet  lists. 


22 


REGULAR  HOUSE   DIET 


Supper. 

Tea  or  milk.    Bread  and  butter. 

Cooked  fruit  (prunes,  apples,  or  rhubarb). 

Apricots.  Pears. 

Cold  meat.        Eggs. 

Cereal    with    milk    and    sugar.    Milk-toast. 

Particular  Foods  for  the  Specified  Days 


SUNDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Cold  meat. 

Eggs. 

Tomatoes. 
Baked  potatoes. 
Fresh  fruit. 

MONDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Vegetable    soup. 

Eggs. 

Bacon. 

Roast   mutton. 
Spinach  or  corn. 
Mashed  potatoes. 

Rice  pudding. 

TUESDAY. 

Apricots. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Lamb  stew. 

Cereal  with  milk 

Eggs. 

Boiled  potatoes. 

and  sugar. 

Beets. 

Apples. 

Sago  pudding. 

REGULAR   HOUSE  DIET 

2^ 

WEDNESDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Cold  meat. 

Fresh  fish. 

Baked   potatoes. 

Rhubarb   or 

Boiled  onions. 

prunes. 

Baked   apples. 

THURSDAY. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Pea  soup. 

Milk-toast. 

Eggs. 

Roast  mutton. 
Mashed  potatoes. 

Squash. 
Bread  pudding. 

FRIDAY. 

Baked  apple. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Fish. 

Eggs. 

Eggs. 

Boiled  potatoes. 
Macaroni  and 

tomatoes. 
Rice  pudding. 

SATURDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Cornmeal. 

Vegetable    soup. 

Eggs. 

Hash. 

Meat  stew.      Apricots  or  pears, 

Mashed   potatoes. 

Spinach  or  corn. 

Cornstarch  pudding. 

24  CONVALESCENT  DIET 

Approximate  Values  to  be  Given 

Total 
Protein  Carbohydrate  Fat  calories 

Men — 90  gm.  (3  oz.)  •      300  gm.  (10   oz.).     70  gm.  (2)^  oz.)-     2200 
Women.80  gm.  (2%  oz.).  250  gm.  (8J^  oz.).     60  gm.  (2  02.).        1800 

Convalescent  Diet^ 
Each  Day  of  the  Week 

Total  quantity  of  milk  allowed,  not  over  1250  c.c. 
(2^  pints)  daily. 

6  A.  M.:  Milk,  210  c.c.  (7  oz.),  if  desired. 

Breakfast. 

Coffee  or  tea  with  milk  and  sugar,  or  milk. 

I  egg,  or  fresh  fish,  or  plain  stew. 

Cereal    with    milk    and    sugar. 

Toast  and  butter   or  rolls  or  bread  (white,  graham 

or  brown). 

Fresh  fish.    Stew. 

Dinner, 

Broth  or  soup  with  barley  or  vegetables 

Bread   and    butter.        Milk. 

Potatoes,  baked,  boiled,  or  mashed. 

Rice,  macaroni,  or  hominy. 

Beef,  chicken,  or  fish. 

Pudding,  ice-cream,  or 

Fruit. 

^  Modified  from  New  York  Hospital  diet  lists. 


CONVALESCENT  DIET 


25 


Supper. 

Tea  or  milk.  Toast  and  butter  or  bread. 

Cooked  fruit  (apples,  stewed  or  baked,  prunes,  rhubarb, 

apricots,  or  pears). 

Egg. 
8  P.  M.:  Milk,  210  c.c.  (7  oz.). 

Particular  Foods  for  the  Specified  Days 


SUNDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Egg. 

I  egg. 

Baked  potato. 
Orange. 

MONDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Roast-beef. 

Egg. 

Stew. 

Mashed  potato. 

Pears  or 

Rice  pudding. 

apricots. 

TUESDAY. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Fresh  fish. 

Egg. 

I  egg. 

Boiled  potato. 

Hominy. 

Ice-cream. 

Apples  (stewed) 

26 


CONVALESCENT  DIET 


WEDNESDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken 

Egg- 

Fresh  fish. 

Baked  potato. 

Rhubarb  or 

Macaroni. 

prunes. 

Tapioca  pudding. 

THURSDAY. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Boiled  beef. 

Egg. 

I  egg. 

Mashed  potato. 

Rice. 
Baked  custard. 

FRIDAY.    - 

Baked  apple. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Fresh  fish. 

Egg. 

Egg. 

Boiled  potato. 
Macaroni. 
Ice-cream. 

SATURDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Cornmeal. 

Chicken. 

Egg. 

Stew. 

Mashed  potato. 

Apricots  or 

Hominy. 

pears. 

Cornstarch  pudding. 

Approximate  Values  to  he  Given 

Total 

Protein 

Carbohydrate 

Fat            calories 

Men loo  gm. 

(3H 

oz.).  300  gm.  (10  oz.).     9ogm.  (3      oz.).  2500 

Women.  80  gm. 

(2% 

oz.).  300  gm.  (lo  oz.).    80  gm.  {2%  oz.).  2200 

soft  diet  27 

Soft  Diet 
Soft  diet  is  the  same  as  the  convalescent  diet,  omitting 
meat,  fish,  and  green  vegetables. 

Approximate  Values  to  be  Given 

Total 
Protein  Carbohydrate  Fat  calories 

Men...  .6ogm.  (2     oz.).  350  gm.  (11%  oz.).  60  gm.  (2      oz.).  2200 
Women.so  gm.  (i^  oz.).  300  gm.  (10     oz.).  50  gm.  (l^  oz.).  1800 

Milk  Diet 
Milk,  3000  c.c.  (3  quarts).     This  gives:  Protein,  100 
gm.  (3^  oz.);  fat,  120  gm.  (4  oz.);  carbohydrate,  150 
gm.  (5  oz.);  calories,  2160;  chlorids,  5.2  gm. 

Liquid  Diet 

Coffee 165  c.c.  (5^^  oz.) 

Broth 675  c.c.  (223^  oz.) 

Gruel 200  c.c.  (6%  oz.) 

Tea 200  c.c.  (6%  oz.) 

Milk 600  c.c.  (20  oz.) 

Sugar 60  gm.  (2  oz.) 

Egg-albumin 90  gm.  (3  oz.) 

Lemon-juice 60  gm.  (2  oz.) 

This  gives:  Protein,  47  gm.  (ij^^  oz.);  fat,  28  gm.  (i 
oz.);  carbohydrate,  108  gm.  {^}i  oz.);  calories,  900; 
chlorids,  2.6  gm. 

Comments  on  Regular  House  Diet,  Convalescent 
Diet,  and  Soft  Diet 

Regular  house  diet,  convalescent  diet,  and  soft  diet 
speak  for  themselves,  and  are  of  particular  use  in  hospi- 


28  SOFT  DIETS 

tal  or  institutional  dietaries.  The  variety  of  foods  in- 
cluded is  considerable,  and  should  one  desire  to  keep 
institutional  expenses  at  a  lower  level,  this  can  be  easily 
done  by  substituting  the  less  expensive  food  stuffs, 
keeping,  however,  to  the  same  general  plan.  Convales- 
cent diet  should  be  of  a  higher  nutritive  value,  more 
easily  digestible,  and  contain  more  protein,  and  this 
change  from  regular  house  diet  is  indicated. 

Soft  diet,  representing  an  intermediate  step  between 
fluid  or  milk  diet  and  convalescent  or  regular  diet,  need 
not  be  so  strictly  adhered  to  in  point  of  food  values,  as  a 
patient's  appetite  can  be  relied  upon  at  this  stage  to 
take  a  sufficient  quantity. 

For  institutions,  however,  it  is  well  to  have  this  also 
standardized  for  economy  in  planning. 

Fluid  diet,  while  it  contains  a  fair  amount  of  protein 
food,  is  of  exceedingly  low  caloric  value,  and  represents 
what  may  be  well  to  give  during  the  first  day  or  two  of 
any  acute  illness,  when  one  wishes  to  rest  the  organism 
without  subjecting  it  to  protein  starvation. 

Milk  diet,  except  as  modified  upward  in  the  typhoid 
milk  diets,  is  of  use  for  a  time,  particularly  in  an  acute 
or  occasionally  in  a  chronic  renal  condition,  its  great 
objection  being  that,  in  order  to  give  the  necessary 
calories  for  a  man,  one  must  give  large  amounts  of  milk, 
3000  to  4000  c.c.  (t,  to  4  quarts),  which  would  mean 
that  the  individual  must  consume  100  to  130  gm. 
(3  to  4  02.)  of  protein,  an  unnecessary  strain  to  put 


SOFT  DIETS  29 

upon  excretory  organs  already  disabled  by  disease. 
So  that,  while  we  give  not  more  than  3000  c.c.  (3  quarts) 
per  day  for  milk  diet,  it  must  be  remembered  that  this 
should  not  be  indefinitely  continued. 


TYPHOID  DIETS 
Typhoid  Fluid  Diet  (No.  ty 

8  A.  M.:  Milk  and  coffee,  each  120  c.c.  (4  oz.),  240  c.c. 

(8  oz.). 
10  A.  M.:  Milk,  hot  or  cold,  240  c.c.  (8  oz.). 
12  noon:  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk,  60 
c.c.  (2  oz.). 
2  p.  M.:  Milk,  240  c.c.  (8  oz.). 
4  p.  M. :  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk,  60 

c.c.  (2  oz.). 
6  P.  M.:  Custard  with  lactose  (full  cup). 
8  P.  M. :  Hot  milk,  240  c.c.  (8  oz.). 
10  P.  M. :  Whey,  180  c.c.  (6  oz.),  with  one  whole  egg  and 

sherry. 
12  P.  M.:  Oatmeal  gruel,  120  c.c.  (4  oz.),  milk,  60  c.c. 
(2  oz.). 
2  A.  M.:  Milk,  240  c.c.  [S  oz.). 
4  A.  M.:  Broth,  240  c.c.  (8  oz.),  with  one  whole  egg. 
6  A.  M.:  Milk,  240  c.c.  (8  oz.). 

Approximate  V allies 

Protein,  98  gm.  (33^  oz.) ;  fat,  52  gm.  (1%  oz.) ;  carbo- 
hydrates, 150  gm.  (5  oz.) ;  calories,  1900. 

»  F.  P.  Kinnicutt. 
30 


typhoid  diets  3i 

Typhoid  Fluid  Diet  (No.  2)» 
{Lower  Protein) 

8  A.  M.:  Milk  and  coffee,  each  120  c.c.  (4  oz.). 
10  A.  M.:  Milk,  hot  or  cold,  240  c.c.  (8  oz.). 
12  noon:  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk, 
60  c.c.  (2  oz.). 

2  P.  M. :  Junket  with  cane-  and  milk-sugar. 

4  P.  M.:  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk,  60 

c.c.  (2  oz.). 
6  P.  M. :  Junket  with  cane-  and  milk-sugar. 
8  p.  M.:  Hot  milk,  240  c.c.  (8  oz.). 
10  p.  M.:  Whey,  180  c.c,  with  one  whole  egg  and  sherry, 
12  p.  M.:  Oatmeal  gruel,   120  c.c.   (4  oz.),  with  milk, 

60  c.c.  (2  oz.). 
2  A.  M. :  Junket  with  cane-  and  milk-sugar. 
4  A.  M.:  Milk,  240  c.c.  (8  oz.). 
6  A.  M.:  Milk,  240  c.c.  (8  oz.). 

15  gm.  (^  oz.)  of  lactose  added  to  the  four  milk 
feedings. 

Approximate  Values 

Protein,  71  gm.  (2^  oz.) ;  fat,  81  gm.  {2%  oz.) ;  carbo- 
hydrates, 160  gm.  (53^  oz.);  calories,  2300, 

These  typhoid  fluid  diets  can  be  further  augmented  by 
the  addition  of  the  following  articles: 
Lactose  or  cane-sugar,  30  gm.  (i  oz.),  120  calories. 

1 F.  p.  Kinnicutt. 


32  TYPHOID   DIETS 

Pea  soup  (see  Special  Recipes),  i8o  c.c.  (i  cup,  6  oz.), 

192  calories  (7.5  gm.  protein). 
Bean  soup  (see  Special  Recipes),  180  c.c.  (i  cup,  6  oz.), 

242  calories  (12  gm.  protein). 
Soda  cracker  (one),  30  calories  (.5  gm.  protein). 

Cream 100  c.c.  (3H  oz.). 

Sugar  or  lactose. .     60  gm.  (2  oz.).        500  calories. 
Gruel 150  c.c.  (5  oz.). 

This  adds  protein,  5  gm.  (}4  oz.) ;  fat,  20  gm.  {%  oz.) ; 
carbohydrates,  75  gm.  (2)^  oz.). 

Typhoid  Diet  Without  Milk 

6.30  A.  M.:  Cup  of  hot  coffee,  sugar  8  gm.  (5"),  two 

slices  zweibach  or  toast  (softened),  butter. 

8.30  A.  M. :  One   portion   of   oatmeal   or   Robinson's 

prepared   barley.     Six   buttered  crackers 

or  sal  tines. 
10.30  A.M.:  Soup,   various    kinds,    180    c.c.    [6    oz.) 

One  soft  egg. 
12.30  p.  M.:  One  medium  sized  baked  potato  mashed 

and  prepared  with  butter  and  salt.     Cup 

of  hot,  weak  tea  with  sugar,  8  gm.  (3ii)- 
2.30:  Two  tablespoons  of  pudding — tapico  or  bread. 

Six  saltines  and  butter.    One  soft  egg. 
4.30:  Rice,  farina  or  cream  of  wheat,  60  gm.  (2  oz.), 

with  butter,  30  gm.  (i  oz.)  and  sugar,  15 

gm.  m  oz.). 


TYPHOID   DIETS  33 

6.30:  Three  slices  buttered  toast.     One  soft  egg. 
8.30:  Soup,  180  c.c.  (6  oz.). 

Approximate  Values 

Protein,  72  gm.  {2}'^  oz.) ;  fat,  126  gm.  (4  oz.) ;  carbo- 
hydrate, 346  gm.  (12  oz.);  calories,  2660. 

MoDinED  Milk  Fluid  Diets  > 

For  1000  calories  a  day:  Calories 

Milk,  icxDO  c.c.  (i  quart) 700 

Cream,  50  c.c.  {1%  oz.) 100 

Lactose,  50  gm.  (1%  oz.) 200 

This  furnishes  eight  feedings,  each  containing: 

Milk,  120  c.c.  (4  oz.). 80 

Cream,  8  gm.  (2  dr.) 15 

Lactose,  6  gm.  {1}^  dr.) 24 

For  1500  calories  a  day: 

Milk,  1500  c.c.  (i^  quarts) 1000 

Cream,  50  c.c.  {1%  oz.) 100 

Lactose,  100  gm.  (33^  oz.) 400 

This  furnishes  six  feedings,  each  containing: 

Milk,  240  c.c.  (8  oz.) 160 

Cream,  8  gm.  (2  dr.) 15 

Lactose,  16  gm.  (4  dr.) 64 

*  Coleman,  American  Journal  of  Medical  Sciences,  January,  191 2. 
3 


34  TYPHOID   DIETS 

For  2000  calories  a  day: 

Milk,  1500  c.c.  {i}4,  quarts) 1000 

Cream,  240  c.c.  (8  oz.) 500 

Lactose,  120  gm.  (4  oz.) 500 

This  furnishes  seven  feedings,  each  containing: 

Milk,  210  c.c.  (7  oz.) 140 

Cream,  30  c.c.  (i  oz.) 60 

Lactose,  18  gm.  (4^  dr.) 72 

For  2500  calories  a  day: 

Milk,  1500  c.c.  {i}4  quarts) 1000 

Cream,  240  c.c.  (8  oz.) 500 

Lactose,  240  gm.  (8  oz.) 1000 

This  furnishes  seven  feedings,  each  containing: 

Milk,  210  c.c.  (7  oz.) 140 

Cream,  30  c.c.  (i  oz.) 60 

Lactose,  36  gm.  (9  dr.) 144 

For  3000  calories  a  day: 

Milk,  1500  c.c.  (i3^  quarts) 1000 

Cream,  480  c.c.  (i  pint) 1000 

Lactose,  240  c.c.  (8  oz.) 1000 

This  furnishes  eight  feedings,  each  containing: 

Milk,  180  c.c.  (6  oz.) 120 

Cream,  60  c.c.  (2  oz.) 120 

Lactose,  30  gm.  (i  oz.) 120 

For  3900  calories  a  day: 

Milk,  1500  c.c.  (i3^  quarts) 1000 

Cream,  480  c.c.  (i  pint) 1000 

Lactose,  480  gm.  (16  oz.) 1900 


TYPHOID   DIETS  35 

This  furnishes  eight  feedings,  each  containing: 

Milk,  i8o  c.c.  (6  oz.) 120 

Cream,  60  c.c.  (2  oz.) 120 

Lactose,  60  gm.  (2  oz.) 240 

Typhoid  Soft  Diet  ^ 

Use  cream,  40  per  cent.  (16  oz.),  for  each 

patient  (Q.  D.): 

Calories 
6.00  A.  M.  to  8.00  P.  M.:  Pasteurized  milk,  180 

c.c.  (6  oz.) 120 

Cream,  30  c.c.  (i  oz.) 100 

Each  glass 2  20 

Q.  2  H.     Eight  glasses 1760 

Breakfast. 

Calories 

1  soft-boiled  egg 60 

2  tablespoonfuls    hominy    or    farina    (well 

cooked) 100 

With  milk,  90  c.c.  (3  oz.) 60 

With  cream,  60  c.c.  (2  oz.) 200 

420 

Dinner. 

Calories 

Beef-juice,  scraped  beef,  each  30  c.c.  (i  oz.) .  50 

Oatmeal  gruel,  240  c.c.  (8  oz.) 100 

With  cream,  60  c.c.  (2  oz.) 200 

3  tablespoonfuls  ice-cream 200 

550 
^  L.  A.  Conner,  New  York  Hospital  Diets. 


36  TYPHOID   DIETS 

Supper. 

Calories 

I  soft-boiled  egg 60 

3  tablespoonfuls  wine-jelly  or  custard,  or  oat- 
meal gruel,  240  c.c.  (8  oz.) 100 

With  cream,  60  c.c.  (2  oz.) 300 

460 

Approximate  values  of  this  diet  are  protein,  loi  gm. 
i^yi  oz.);  carbohydrate,  172  gm.  (5%  oz.);  fat,  176  gm. 
(6  oz.);  calories,  3190. 

Comments  on  Typhoid  Fever  Diet 

Many  cases  of  typhoid  when  seen  for  the  first  time, 
either  in  the  hospital  or  private  practice,  have  been  ill 
for  a  number  of  days,  and  are  very  apt  to  have  a  diar- 
rhea, which  is  not,  strictly  speaking,  a  part  of  their 
disease,  but  a  complication,  brought  on  by  improper 
feeding.  In  such  cases  it  is  best,  after  the  initial 
emptying  of  the  intestinal  canal  by  mild  catharsis  or 
enemata,  to  prescribe  a  diet  which,  while  it  is  too  low  in 
heat  units,  still  has  a  fair  amount  of  protein,  and  has  an 
added  advantage  over  a  strictly  milk  diet  in  that  it  is 
quite  varied  in  composition.  Such  a  diet  is  given  in  the 
typhoid  liquid  diets,  and,  while  one  could  often  advan- 
tageously give  the  ordinary  fluid  diet  for  this  period, 
the  special  typhoid  liquid  diet  furnishes  almost  twice 
as  much  protein  and  twice  as  many  calories. 

When  the  patient  is  ready  for  more  food  this  list  of 


TYPHOID   DIETS  37 

articles  can  be  further  reinforced  by  the  addition  of 
cream,  lactose,  eggs,  and  more  gruel,  or  one  can  make 
use  of  one  of  the  cream,  milk,  and  lactose  mixtures  given 
in  the  diet  lists  devised  by  Dr.  Warren  Coleman.  There 
h,  however,  a  distinct  advantage  in  the  greater  variety 
of  foods  in  the  first  list,  and  it  has  been  the  experience 
of  many  that  it  is  better  borne.  In  early  convalescence 
the  soft  typhoid  diet  will  be  found  convenient,  as  repre- 
senting a  good  amount  of  protein  and  a  larger  number  of 
calories  without  irritating  or  coarse  residue.  There  is 
apparantly  no  question  among  clinicians  nowadays  that 
typhoid  patients  do  better  on  a  more  liberal  supply  and 
variety  of  foods  than  on  a  monotonous  and  insufficient 
milk  diet — complications  are  fewer  (?)  and  convales- 
cence is  shortened.  Coleman  and  Schaefer  have  ably 
demonstrated  that  the  body  is  able,  even  in  high  fever, 
to  digest,  absorb,  and  properly  utilize  quantities  of 
food  sufficiently  large  to  maintain  nitrogenous  equi- 
librium and  body  weight,  their  cases  often  actually 
gaining  weight  during  the  fever. 

There  never  was  a  class  of  patients,  however,  who 
needed  more  individual  care  in  the  selection  of  the  kind 
and  quantity  of  food  given  than  typhoid  fever  patients, 
and,  while  the  high  caloric  feeding  is  a  great  step  in 
advance,  it  must  be  individualized  for  the  patient  and 
always  arrived  at  gradually;  i.e.,  it  is  not  well  to  go  from 
a  low  caloric  to  a  high  caloric  diet  without  a  gradual 
increase  from  one  to  the  other. 


38  TYPHOID   DIETS 

Just  here  it  might  be  added  that  when  a  patient's 
digestion  fails  to  take  care  of  the  larger  amounts  of  food, 
as  shown  by  tympanites,  flatulence,  etc.,  the  use  of 
buttermilk  or  milk  artificially  ripened  by  some  form  of 
the  lactic  acid  bacillus  (see  Special  Recipes),  if  given  in 
moderate  amount  wherever  fresh  milk  is  being  used, 
will  often  stop  the  intestinal  fermentation  at  once.  It 
is  almost  as  useful  when  a  patient's  stomach  becomes 
disturbed,  as  shown  by  nausea  or  vomiting. 

In  some  cases  where  the  tympanites  is  severe,  it  may 
be  necessary  to  withhold  all  food  for  a  time  or  to  re- 
strict the  diet  to  broths.  There  are  also  certain  patients 
who  cannot  take  milk  in  any  form  without  distressing 
disturbances.  In  these  latter  cases  a  diet  without  milk 
may  be  arranged  somewhat  as  shown,  regulating  the 
amount  of  protein  and  the  number  of  calories  according 
to  the  demands  of  the  case. 

The  transition  from  typhoid  soft  to  convalescent  diet 
is  easily  made,  although  fruits  and  green  vegetables 
should  be  excluded  at  first.  Patients  should  usually 
be  wakened  for  feedings. 


DIET  IN  PNEUMONIA 

8  A.  M.:  Milk,  coffee,  120  c.c.    each  (4  oz.),  240  c.c. 
(8  oz.).     (If  coffee  disagrees,  the  milk  may  be 

flavored  with  tea  or  cocoa.) 
10  A.  M. :  Gruel,  any  form,  120  c.c.  (4  oz.)  with  milk, 

180  c.c.  (6  oz.). 
12  noon:  Milk,  hot  or  cold,  or  as  junket,  240  c.c.  (8 

oz.).    Add  salt. 
2  p.  M. :  Same  as  10  a.  m. 
4   p.  M.:  Same  as  noon. 
6  p.   M.:  Custard  with  lactose,  i  cup  (4  oz.). 
8   p.  M.:  Milk,  240  c.c.  (8  oz.). 
10  p.  M.:  Whey,   180   c.c.  (6  oz.)  with  one  whole  egg, 

sherry  flavor,  15  c.c.  (3^  oz.). 
12  p.  M.:  Gruel  as  at  10  a.  m. 

2   A.  M. :  Milk,  240  c.c.  (8  oz.)  in  any  form  preferred. 
4  A.  M.:  Whey,  180  c.c.  (6  oz.)  or  hot  milk,  240  c.c. 

(8  oz.). 
6  A.  M.:  Milk,  240  c.c.  (8  oz.). 

This  represents  approximately: 

Protein,  90  gm.  (3  oz.) ;  fat,  90  gm.  (3  oz.) ;  carbohy- 
drates, 225  gm.  (j^i  oz.);  calories,  1800. 

The  caloric  value  of  this  diet  may  be  increased  by 
adding  120-240  c.c.  cream  (4-8  oz.). 

39 


4©  DIET  IN   PNEUMONIA 

If  milk  disagrees  for  any  reason,  buttermilk  or  ripened 
milk  may  be  substituted,  or  the  typhoid  diet  without 
milk  may  be  tried.  Broth  may  be  given  in  addition  as 
it  is  good  for  its  appetizing  qualities,  although  of  little 
nutritional  value. 

Comment  on  Pneumonia 

Pneumonia  being  for  the  most  part  a  self -limited  and 
comparatively  short  disease,  the  need  for  absolute  diet- 
ary regulation  from  the  nutritional  standpoint  is  not 
always  necessary  and  one  must  often  be  content  to  do 
the  best  one  can,  so  far  as  feeding  definite  amounts  of 
food  goes.  Care  must  be  taken  not  to  give  those  foods 
which  are  prone  to  fermentation  or  tend  to  the  produc- 
tion of  gas,  as  abdominal  distention  is  to  be  avoided, 
when  possible,  at  all  costs.  At  the  same  time  these 
patients  should  receive  food  regularly  and  in  fair 
amount,  although  not  necessarily  up  to  ordinary  nutri- 
tional requirements.  One  absolute  requirement  in 
these  cases  is  an  abundance  of  water  and  a  pitcher  of 
this  should  always  be  at  hand.  The  use  of  fruit  juices 
diluted  with  water  is  an  excellent  practice,  orange  juice, 
lemon  juice,  or  grape  juice  are  particularly  grateful. 
One  of  the  typhoid  liquid  diets  would  form  the  basis  of 
a  very  good  feeding  routine  in  Pneumonia  or  that 
already  given.     The  patient  should  not  be  wakened. 


NEPHRITIC  DIETS 

Salt-poor  Diets 
Salt-poor  diet,  no.  I 

Breakfast.  Gm.  Oz. 

Bread 30  i 

Sugar 10  yi 

Farina 60  2 

Butter 30  I 

Egg  (i) 40  iH 

Coffee 150  c.c.    5 

320  10% 

Dinner.  Gm.  Oz. 

Bread 30  i 

Butter 20  % 

Sugar 10  yi 

Rice 60  2 

Farina 100  t,}^^ 

Tea 150  c.c.    5 

370  12H 

Supper.  Gm.  Oz. 

Egg  (i) 40  iH 

Toast 15  K 

Bread 30  i 

Butter 15  3'^ 

Custard 100  33'^ 

Prunes 60  2 

Tea 180  c.c.   6 


440        14% 
41 


42  SALT-POOR   DIETS 

This  contains  chlorids,  i  gm. ; protein,  35  gm.  (i}^  oz.) ; 
fat,  65  gm.  {2}^  oz.);  carbohydrate,  140  gm.  (4^ 
oz.) ;  calories,  1300. 

SALT-POOR  DIET,  NO.  2 

Breakfast.  Gm.         Oz. 

Bread 60  2 

Sugar 40  i}i 


Farina 60  2 


Butter 35  iH 


Egg  (i) 40  iM 

Coffee 150  c.c.    5 

385        12^ 

Dinner,  Gm.  Oz. 

Egg(i) 40  iH 

Bread 60  2 

Butter 30  I 

Rice 70  2}i 


Farina 100  3H 


Tea 150  c.c.    5 


450  IS 
Supper.                Gm.  Oz. 

Egg(i) 40  iH 

Toast IS  H 

Bread 60  2 

Butter 30  I 

Custard *. 100  3H 

Prunes 60  2 

Tea 180  c.c.    6 

48s  15% 


SALT-POOR  DIETS  43 

This  contains  chlorids,  1.3  gm.;  protein,  50  gm. 
(1%  oz.);  fat,  100  gm.  (33="^  oz.);  carbohydrate,  240  gm. 
(8  oz.);  calories,  2100. 

TSALT-POOR   DIET,  NO.  3 

Breakfast.  Gm.  Oz. 

Bread 30  i 

Egg I 

Oatmeal 60  2 

Orange  juice 200  c.c.  6% 

Sugar 25  ^i 

Butter 20  % 

Cream 50  1% 

Luncheon.  Gm.  Oz. 

Potato 50  1% 

Bread 30  i 

Rice 80  2% 

Tomato.. 100  3)'| 

Butter 20  % 

Raisins 15  3^ 

Sugar 10  y^ 

Ice-cream 100  3)^ 

Supper.  Gm.  Oz. 

Bread 40  1]/^ 

Butter 30  I 

Oatmeal 60  2 

Cream 50  1% 

Raisins 10  ^i 

Sugar 35  I 

Potato 50  1% 

Egg  (i) 


44  SALT-POOR  DIETS 

Approximate  Values 
Protein,  37  gm.  {1%  oz.);  (5.9  gm.  nitrogen) ;  calories, 
2000;  chlorids  less  than  i  gm.  (15  grains). 

SALT-POOR    DIET,  NO.  4 

Breakfast.  Gm.  Oz. 

Bread 60  2 

Orange  juice 200  c.c.    6% 

Butter 40  i^i 

Cream 30  i 

Farina 50  1% 

Sugar ^30  I 

Coffee  or  tea 180  c.c.    6 

Dinner.  Gm.  Oz. 

Bread 40  i 

Butter 20  % 

Egg I  I 

Potato 125  4 

Cream  cheese 20  % 

Sugar 30  I 

Rice 50  1% 

Cream 30  i 

Supper.  Gm.  Oz. 

Bread 50  1% 

Butter 35  I 

Farina 50  1% 

Cream 40  i^i 

Cream  cheese 30  i 

Olive  oil 15  }4, 

Lactose 8  ^-^ 

Sugar 30  I 

Potato 75  2>^ 


SALT-POOR  DIETS  45 

Appraxintate  Values 

Protein, 35  {i^i  oz.) ;  ('5.6 gm.  nitrogen) ;  calories,  2600 ; 
chlorids,  less  than  i  gm.  (15  grains). 

May  have,  in  addition,  moderate  amounts  of:  toma- 
toes, celery,  lettuce,  cabbage,  cauliflower,  spinach 
(fresh),  beets,  carrots,  squash,  oranges,  grape  fruit, 
peaches,  grapes,  prunes,  apricots,  pears,  melons,  and 
jams. 

SALT-POOR   DIET*  NO.  5 

Breakfast.  Gm.  Oz. 

Bread 60  2 

Orange  juice 200  6% 

Butter 30  I 

Eggs 2 

Oatmeal 90  3 

Prunes 50  1% 

Cream 40  i}'i 

Sugar 50  iH 

Tea  or  coffee 150  c.c.  5 

Dinner.  Gm.  Oz. 

Bread 40  i^i 

Butter 10  yi 

Potato 80  lyi 

Meat,  choice  of 

Lamb  chop  or 100  2>}'ii 

Sirloin  steak  or 100  3^ 

Fish  or 70  1 3^ 

Chicken 125  4 

Rice 80  2% 

Cream 20  ^i 

Vegetables — from  list. 


46  SALT-POOR  DIETS 

Supper.  Gm.  Oz. 

Bread 50  1% 

Butter 30  I 

Cream 40  i^| 

Lactose 8  ^^ 

Oatmeal 30  i 

Prunes 100  ^^i 

Olive  oil 20  % 

Egg 2  I 

Sugar  (cane) 30  5 

Tea 150  5 

Approximate  Values 

Protein,  69  gm.  {i^i  oz.);  nitrogen,  11  gm.  {%  oz.); 
chlorids,  i  gm.  (15  grains);  calories,  3000. 

The  same  list  of  accessory  fruits  and  vegetables  that 
was  given  with  Diet  No.  4  is  available  here. 

These  diets  are  intended  to  be  palatable,  low-protein, 
salt-poor  diets  and,  therefore,  too  great  liberality  of 
choice  is  given  to  permit  of  a  very  considerable  accuracy 
in  estimating  the  nitrogen  and  salt.  Since  these  diets 
are  for  therapeutic  rather  than  investigative  use,  the 
patients  need  not  be  required  to  finish  each  portion  but 
they  should  be  encouraged  to  eat  the  full  amount  when 
they  can  do  so  with  moderate  comfort.  Diets  4  and 
5  consist  of  a  constant  framework  and  a  list  of  acces- 
sory foods  that  may  be  varied  at  will.  The  diets  can 
be  distributed  throughout  the  day  to  suit  the  con- 
venience of  the  nurse  and  patient.     These  foods  must, 

of  course,  be  prepared  and  served  without  salt. 

Note. — The  next  step  after  salt-poor  diet  No.  5  would  be  soft  or 
convalescent  diet  served  without  salt  shaker,  but  cooked  with  a 
palatable  amount  of  salt. 


salt-poor  diets  47 

Directions  for  Schlayer's  Nephritic  Test  Day 
(Mosenthal) 

Needed  in  the  ward: 
7  wide-necked  bottles,  each  labelled. 
I  bottle  to  hold  looo  c.c.  for  night  specimen, 
6  bottles  to  hold  500  c.c.  each,  for  two-hour  speci- 
mens during  day. 

Salt  in  capsules,  each  capsule  to  contain  2.3  grams 
sodium  chlorid. 

Preceding  day's  diet  should  be  soft  salt-poor  with 
fluids  limited  to  1500  c.c. 

Test  Day. — All  food  is  to  be  salt-free,  from  diet 
kitchen. 

Salt  for  each  meal  will  be  furnished  in  weighed 
amounts  (one  capsule  containing  2.3  grams,  sodium 
chlorid  with  each  meal). 

All  food  or  fluid  not  taken  must  be  weighed  or  meas- 
ured after  meals  and  charted. 

Allow  no  food  or  fluid  of  any  kind  except  at  meal 
times  as  directed. 

Note  any  mishap  or  irregularities  that  occur  in  giving 
the  diet  or  in  collection  of  specimens. 
Meals  to  be  given  at  the  following  hours: 
Breakfast,       7.45  A.  M. 
•  Dinner,  1145  a.  m. 

Supper,  4.45  p.  M. 

No  fluids  between  meals  or  during  the  night. 
Collection  of  urine  during  the  day  every  two  hours, 
and  from  7.45  p.  m.  to  7.45  a.  m. 


48  SALT-POOR   DIETS 

Empty  bladder  at  the  following  times: 
No.  of  specimen       7.45  a,  m.  discard. 

1  9.45  A.  M.  save  in  separate  bottle. 

2  11-45  ^-  ^'  save  in  separate  bottle. 

3  1 .45  p.  M.  save  in  separate  bottle. 

4  3.45  p.  M.  save  in  separate  bottle. 

5  5.45  p.  M.  save  in  separate  bottle. 

6  7.45  P.  M.  save  in  separate  bottle. 

7  7.45  p.  M.  to  7.45  A.  M. 

Label  each  bottle  with  period  of  collection,  number  of 
•specimen  and  name  of  patient  and  send  to  laboratory. 
Breakfast:  7.45  A.  m.     Chart  food  or  fluid  not  taken. 
Boiled  oatmeal,  100  grams  (33=^^  oz.) ;  sugar,  one-half 

teaspoonful. 
Milk,  30  c.c.  (i  oz.). 
Two   slices   of   bread    (30   grams   each)    (i    oz,); 

butter,  20  grams  (%  oz.). 
Coffee, *i6o  c.c.  (sH  oz.);  milk,  40  c.c.  {i}i  oz.); 

sugar,  one  teaspoonful. 
Milk,  200  c.c.  (6%  oz.). 
Water,  200  c.c.  (6%oz.). 
Dinner;  11.45  A.  M. 

Meat  soup,  180  c.c.  (6  oz.). 

Beefsteak,  100  grams  (33^  oz.). 

Potatoes  (baked,   mashed    or  boiled),  130  gramsr 

{4H  oz.). 
Green  vegetables  as  desired. 
Two  slices  bread  (30  grams  each)  (i  oz.);  butter, 
20  grams  {%  oz.). 


SALT-POOR  DIETS 


49 


Tea,  i8o  c.c.  (6  oz.) ;  milk,  20  c.c.  {%  oz.) ;  sugar, 

one  teaspoonful. 
Water,  250 c.c,  (83-^  oz.). 

Pudding,  (tapioca  or  rice),  no  grams  (3%  oz.). 
Supper:  4.45  p.  m. 

Two  eggs  (cooked  in  any  style). 

Two  slices  of  bread  (30  grams  each)  (i  oz.) ;  butter, 

20  grams  (%  oz.). 
Tea,  180  c.c.  (6  oz.) ;  milk,  20  c.c.  (%  oz.) ;  sugar, 

one  teaspoonful. 
Fruit,  stewed  or  fresh,  one  portion. 
One  capsule  of  salt  with  each  meal  3  X  2.3  grams. 

Urinary  Findings  in  a  Case  of  Chronic  Hypertensive  Nephritis 


Urine, 

amount 

c.c. 

Sp. 
gv. 

Sodium      1 
chlorid        | 

Nitrogen 

Approximate 

Per 
cent. 

Total 

Per 
cent. 

Total 

intake 

7.4s  to   9.45 
0.4s  to  1 1. 4"; 

ISO 
102 

90 
263 

60 
320 

lOII 

IOI4 
IOI3 

lOIO 
lOII 

IOI5 

Fluids    1700  C.C. 
Salt  10  gm. 
Nitrogen  15  gm. 

11.45  to  1.45 
1.45  to  3.45 
3.45  to  5.45 
5-45  to  7.45 

Total  day. . . . 
Total  night.. 

985 
800 

IOI3 

o.is 
0.2 

1.47 
1.6 

0.37 
0.48 

363 
3.8s 

Total  24  hours 

1785 
1700 

307 
10. 0 

7-49 
ISO 

Intake 

Balance . . . . 

-8S 

+6.93 

+7.51 

These  figures  show  a  negative  water  balance,  but  retention  of 
ohlorids  and  nitrogen. 


5©  SALT-POOR  DIETS 

Comments  on  Use  of  Salt-poor  Diets* 

In  the  use  of  salt-poor  diets,  or  so-called  salt-" free" 
diets  (although  none  of  them  can  be  actually  salt  free) , 
a  great  step  in  advance  has  been  made  in  the  dietetic 
treatment  of  edema,  particularly,  but  not  exclusively, 
of  renal  origin.  We  are  more  indebted  to  Widal  than 
to  any  other  one  man  for  putting  this  therapeutic 
measure  on  a  firm  basis.  Of  course,  it  is  particularly 
useful  in  edema  associated  with  a  greater  or  lesser  de- 
gree of  impermeability  of  the  kidney  to  salt.  The  two 
requisites  for  the  successful  use  of  this  form  of  treatment 
are,  proper  selection  of  cases  and  the  continued  and 
faithful  use  of  a  diet  that  is  as  nearly  salt  free  as  possible. 
In  other  words,  while  the  edema  in  many  cases  of  this 
kind  begins  to  clear  up  at  once  on  this  diet  (although  it 
has  resisted  all  other  physical  and  medical  measures), 
in  many  of  them  it  does  not,  and  it  is  not  until  the  pa- 
tients have  been  on  this  diet  for  a  week  or  two  or  longer 
that  apparently  the  kidneys,  having  been  spared  so 
long,  are  able  to  regain  their  lost  power  of  salt  excre- 
tion, and  will  then  go  ahead  and  rapidly  empty  the 
subcutaneous  tissue  of  its  retained  salt  and  water. 

While  it  is  best  to  determine  the  rapidity  of  the  salt 
elimination  in  cases  in  which  the  edema  resists  the 
dietary,  so  that  one  can  be  assured  that  one  is  on  the 

^  In  all  the  salt-poor  diets  the  food  should  be  prepared  absolutely 
without  addition  of  salt.  Salt-free  butter  and  bread  only  are  to  be 
used.    No  extra  salt  allowed. 


SALT-POOR  DIETS  5 1 

right  track,  a  clinical  diagnosis  can  often  be  made  when 
the  edema  is  diminished  promptly.  While,  as  already- 
stated,  this  treatment  is  particularly  indicated  in  a 
special  class  of  renal  disease,  it  is  of  great  assistance  in 
many  forms  of  edema  or  even  serous  effusions.  This  is 
due  no  doubt  to  the  fact  that  the  kidneys  are  spared 
extra  labor  in  the  excretion  of  the  usual  amount  of 
salt  taken  with  the  normal  diet,  and  to  the  fact  that  the 
body,  in  the  presence  of  a  reduced  salt  intake,  seeks 
salt  in  the  tissues  or  serous  spaces  in  order  to  keep  up 
the  normal  salt  concentration  in  the  blood,  as  an  at- 
tempt at  equilibrium  of  the  inorganic  constituents  of 
the  blood  is  in  some  way  automatically  arranged  for. 

With  this  foreword,  the  use  of  the  salt-poor  diets 
becomes  evident  and  needs  little  or  no  further  explana- 
tion. 

Diet  No.  I  may  be  used  at  once  in  very  severe  cases. 
In  milder  cases  No.  2,  No.  3  No.  4  or  No.  5  may  be 
used,  or  they  may  be  used  in  series  as  the  individual 
case  shows  improvement.  The  length  of  time  each 
should  be  used  is  a  matter  for  judgment  on  the  physi- 
cian's part.  Later,  ordinary  mixed  diet  may  be  used 
without  the  use  of  a  salt  shaker,  after  which  definite 
amounts  of  salt  may  be  allowed. 


DIET  IN  ARTERIOSCLEROSIS  AND  HYPERTENSION 

Much  has  been  written  during  the  past  few  years 
relative  to  the  effect  of  foods  on  the  production  of 
arteriosclerosis,  and  hypertension,  but  as  yet  our 
knowledge  is  very  incomplete.  It  seems  fairly  defi- 
nitely established,  however,  that  a  great  excess  of 
food  over  and  above  the  individual  requirements  plays 
a  definite  etiologic  r61e,  and  it  is  certainly  a  frequent 
clinical  observation  that  those  who  habitually  overeat 
are  often  affected  with  these  conditions  separately  or 
together. 

There  seems  a  consensus  of  opinion  that  an  excess  of 
meat  or  meat  products  plays  a  part  in  these  diseases 
and  this  is  not  an  unreasonable  assumption  as  the 
extractives  of  meat  have  definite  blood  pressure  raising 
qualities.  Whether  it  is  true  that  persons  become 
sensitized  to  meat  proteins  or  other  proteins,  which 
then  exert  an  effect  on  the  blood-vessels,  either  causing 
sclerosis  or  hypertension,  has  some  foundation  in 
experimental  medicine,  but  is  not  as  yet  a  settled  ques- 
tion. On  this  basis  Bishop  devised  what  is  called  the 
few  protein  diet  in  which  proteins  are  used  qualitatively, 
and  an  attempt  is  made  to  determine  the  effect  of  the 
different  proteins  on  the  circulation,  specially  with 
reference  to  animal  proteins. 

52 


DIET   IN   ARTERIOSCLEROSIS   AND   HYPERTENSION   53 

As  already  indicated  as  yet  it  is  not  possible  to  pre- 
scribe a  diet  definitely  to  combat  these  conditions  of 
arteriosclerosis  and  hypertension,  but  certain  general 
rules  may  be  followed  to  advantage  by  these  cases. 

1.  Eat  moderate  amounts  only — no  more  than  is 
required  to  meet  physiological  requirements  of  occupa- 
tion. 

2.  Avoid  soups  made  with  "stock."  Eat  meat  not 
more  than  once  a  day  and  in  small  amount;  boiled  meat 
conta  ns  less  of  the  extractives  which  are  definitely 
pressure  raising.  In  other  words,  restrict  the  purine 
intake,  and  take  not  over  60-70  gm.  protein  per  day. 

3.  Avoid  fermentable  foods,  but  take  foods  with  a 
fair  amount  of  roughage. 

4.  Restrict  the  diet  when  necessary  to  meet  condi- 
tions of  disease  of  the  liver,  heart,  kidneys,  or  gastro- 
intestinal tract. 

5.  Exercise  regularly  to  promote  proper  utilization 
of  the  foods. 

6.  Avoid  severe  or  long-continued,  arduous  physical, 
or  mental  work. 

7.  Keep  the  skin,  bowels  and  kidneys  active,  natur- 
ally if  possible,  artificially  if  necessary. 

Karell  Treatment  for  Anasarca' 
For  First  Five  to  Seven  Days 

8.  12  A.  M.;  4,  8  P.  M.:  Milk,  200  c.c. 
No  other  fluids. 

^  From  the  New  York  Hospital  Diet  Lists. 


/ 


54  DIET   IN   ARTERIOSCLEROSIS   AND   HYPERTENSION 

Eighth  Day 
Milk  as  above, 
lo  A.  M. :  I  soft-boiled  egg. 
6  P.  M.:  2  pieces  of  dry  toast. 

Ninth  Day 
Milk  as  above. 

ID  A.M.:  I  soft-boiled  egg  and  2  pieces  of  dry  toast. 
6  p.m.:  I  egg  and  2  pieces  of  dry  toast. 

Tenth  Day 
Milk  as  above. 

12  NOON.:  Chopped  meat,  rice  boiled  in  milk,  vege- 
tables. 
6  P.  M. :  I  soft-boiled  egg. 

Eleventh  to  Twelfth  Days 

Same  as  tenth  day. 

No  salt  is  used  throughout  diet.  Salt-free  toast  and 
butter  used.  Small  amount  of  cracked  ice  allowed  with 
diet.    All  meat  can  often  advantageously  be  omitted. 

Comments  on  Cardiac  Diets 

During  the  early  period  of  cardiac  decompensation 
the  diet  should  be  reduced  to  a  point  somewhat  below 
the  ordinary  requirements  of  the  individual  in  health, 
and  care  should  be  taken  that  foods  prone  to  produce 
gas  or  in  themselves  indigestable  are  omitted  from  such 
a  diet,  i.e.,  cakes,  syrups,  uncooked  vegetables  and 


DIET   IN   ARTERIOSCLEROSIS    AND   HYPERTENSION   55 

fruits,  fried  foods,  cabbage,  cauliflower,  sprouts,  etc. 
When  there  is  marked  decompensation  with  congestion 
of  the  viscera,  the  simplest  sort  of  a  diet  is  in  order,  such 
as  the  soft  diet  and  the  salt-poor  diets  or  when  especially 
marked  and  particularly  when  accompanied  by  obesity, 
the  Karell  diet  is  of  great  value.  The  evening  meal 
should  always  be  light  or  of  small  bulk  in  decompensa- 
tion and  particularly  in  chronic  myocarditis.  The 
Karell  diet  used  in  marked  decompensation  is  almost 
too  well  known  to  need  comment,  and  has  proven  its 
usefulness  during  many  years,  the  limitation  of  the 
fluid  intake  together  with  the  low  food  and  minimal 
salt  content  seem  to  explain  its  action,  while  at  the 
same  time  a  moderate  amount  of  protein  is  furnished. 
Ordinary  soft  diet  or  the  salt-poor  diets  may  also  be 
used  to  advantage. 


GASTRIC  DIETS  ^ 

Lenhartz  Diet 

As  eggs  differ  in  size  and  weight,  take  the  total  of 
eggs  for  the  day  of  diet;  beat,  measure,  and  divide  into 
seven  feedings  and  put  into  medicine-glasses.     Keep  on  ^ 

ice  and  use  as  directed,  alternating  with  milk.  i 

Milk,  iced,  kept  in  bowl  of  cracked  ice.  Eggs  beaten 
up  raw  and  iced.    Spoon  kept  in  bowl  of  ice.  ■ 

Patients  never  allowed  to  help  themselves. 

Slow  feedings  essential,  frequent  small  feedings  fed 
by  spoon. 

First  and  second  days  salt  eggs  to  taste. 

Third  day  sugar  is  started. 

First  Day 

7  A.  M.:  Egg. 

8  A.  M.:  Milk,  20  c.c.  {^i  oz). 

9  A.  M.:  Egg. 

10  A.  M.:  Milk,  20  c.c.  (%  oz.). 

11  A.  M.:  Egg. 

12  noon:  Milk,  15  c.c.  (3^  oz.). 

1  p.  M.:  Egg. 

2  p.  M.:  Milk,  15  c.c.  {}i  oz.). 

3  p.  M.:  Egg. 

S6 


GASTRIC  DIETS  57 

4  P.  M.:  Milk,  15  c.c.  (}4  oz.). 

5  P.M.:  Egg. 

6  p.  M.:  Milk,  15  c.c.  (}4  oz.). 

7  P.  M.:  Egg. 

Total  First  Day. — Eggs  (raw)^  2;  milk,  100  c.c.  (3^^ 
oz.). 

Second  Day 

7  A.  M.:  Egg. 

8  A.  M.:  Milk,  35  c.c.  (i  oz.). 

9  A.  M.:  Egg. 

10  A.  M.:  Milk,  35  c.c.  (i  oz.). 

11  A.  M.:  Egg. 

12  noon:  Milk,  35  c.c.  (i  oz.). 

1  P.M.:  Egg. 

2  P.  M.:  Milk,  35  c.c.  (i  oz.). 

3  P.M.:  Egg. 

4  p.  M.:  Milk,  30  c.c.  (i  oz.). 

5  P.M.:  Egg. 

6  p.  M.:  Milk,  30  c.c.  (i  oz.). 

7  p.  M.:  Egg. 

Total  Second  Day. — Eggs  (raw),  3;  milk,  200  c.c. 
(6%  oz.). 

Third  Day 

7  A.M.:  Egg. 

Sugar,  2  gm.  {}4  dr.). 

8  A.  M.:  Milk,  50  c.c.  (i3i  oz.). 


58  GASTRIC  DIETS 

9  A.  M.:   Egg. 

Sugar,  3  gm.  (Mdr.)- 

10  A.  M.:  Milk,  50  c.c.  {i%  oz.). 

11  A.  M.:  Egg. 

Sugar,  3  gm.  (^^dr.). 

12  noon:  Milk,  50  c.c.  (1%  oz.). 

1  p.  M.:  Egg. 

Sugar,  3  gm.  (M  dr.). 

2  p.  M.:  Milk.,  50  c.c.  {1%  oz.). 

3  P.M.:  Egg. 

Sugar,  3  gm.  {^i  dr.). 

4  p.  M.:  Milk,  50  c.c.  (1%  oz.). 
SP.  M.:  Egg. 

Sugar,  3  gm.  (M  dr.). 

6  p.  M.:  Milk,  50  c.c.  {i%  oz.). 

7  P.M.:  Egg. 

Sugar,  3  gm.  (^dr.). 

Total  Third  Day. — Eggs  (raw),  4;  milk,  300  c.c.  (10 
oz.);  sugar,  20  gm.  (5  dr.). 

This  will  suffice  to  show  the  arrangement  of  the  foods 
and  intervals  of  feeding  in  the  Lenhartz  diet,  the  total 
daily  quantities  being  given  under  the  recapitulation. 


GASTRIC   DIETS 


59 


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6o  GASTRIC  DIETS 

Von  Leube  Treatment  for  Peptic  Ulcer* 

For  the  first  three  days  neither  food  nor  water  is  to  be 
taken  by  mouth,  the  mouth  being  kept  moist  by  washes. 
The  Murphy  drip  is  started  at  once,  using  a  2  per  cent, 
glucose  solution  giving  about  30  drops  per  minute. 
This  supplies  approximately  1500  c.c.  (3  pints)  of  fluid  in 
twenty-four  hours.  It  is  well  to  add  50  grains  (3.3  gm.) 
of  strontium  bromid  to  this,  and  continue  the  drip  for 
five  or  six  days  until  the  patients  are  receiving  sufficient 
fluid  by  mouth.  In  patients  who  are  aged,  debilitated^ 
or  desiccated  by  vomiting  and  insufficient  nourishment, 
the  first  period  of  starvation  is  limited  to  twenty-four 
hours.  On  the  second  day  2  to  4  ounces  of  Celestine 
Vichy  is  given  every  two  hours,  and  on  the  third  day 
alternate  these  doses  with  albumin-water,  so  that 
liquids  are  taken  every  hour. 

During  this  time  hot  applications,  preferably  by  the 
electric  pad,  are  applied  constantly  to  the  epigastrium. 
On  the  fourth  day  from  7  a.  m.  to  8  p,  m.  there  is 
given  on  one  hour  2  ounces  (60  c.c.)  fully  peptonized 
milk  (two-hour  peptonization) ,  the  next  hour  2  ounces 
(60  c.c.)  Celestine  Vichy  or  Siphon  Vichy,  which  has 
been  allowed  to  stand  until  all  the  gas  has  escaped. 
These  are  alternated  hourly  and  each  day  the  milk  and 
vichy  allowance  is  increased  i  ounce  (30  c.c.)  each, 
until  the  milk  reaches  8  ounces  (250  c.c.)  but  the  vichy 

*As  modified  by  Geo.  R.  Lockwood. 


GASTRIC  DIETS  6 1 

is  not  increased  after  the  allowance  reaches  4  ounces 
(120  c.c).  The  hot  applications  are  still  continued 
and  the  patients  kept  quietly  in  bed. 

The  bowels  are  now  kept  open  by  low,  simple  enemata. 
If  there  is  any  acidity,  alkaline  powders  are  given,  but 
otherwise  no  medicine  is  taken.  About  the  tenth  day 
are  added  in  order,  fine  cereal,  milk-toast,  and  junket, 
and  then  one  may  begin  one  of  two  lines  of  treatment. 
If  the  bowels  are  constipated  and  the  breath  offensive, 
start  with  Carlsbad  water,  giving  a  glassful,  hot,  before 
the  first  nourishment.  If  necessary,  one-half  such  dose 
is  to  be  given  the  last  thing  at  night.  If  the  bowels  still 
remain  constipated,  reduce  the  temperature  of  the 
Carlsbad  to  tepid,  giving  practically  a  Markbrunnen 
instead  of  Sprudel.  If  the  bowels  are  not  so  consti- 
pated, and  if  pain  and  acidity  have  been  permanent 
symptoms,  some  rely  on  nitrate  of  silver,  giving  ^^  grain 
three  times  a  day  for  three  days,  %  grain  for  three  days, 
and  %  grain  for  three  days,  and  then  repeat  the  cycle. 
Diarrhea  may  follow  such  dosage. 

During  the  third  week  are  added,  in  order,  spaghetti 
and  macaroni,  creamed  mashed  potato,  fine  cereal,  such 
as  hominy  or  cream  of  wheat,  and  creamed  fresh  fish, 
such  as  creamed  halibut.  Any  vegetable  that  is  put 
through  a  sieve,  such  as  pea  puree,  or  thick  puree  soups, 
without  meat  stock,  may  be  given.  Farinaceous  des- 
serts, such  as  farina,  tapico,  cornstarch,  blanc-mange, 
rice  pudding,  and  custard,  may  also  be  given. 


62  GASTRIC   DIETS 

The  patient  still  remains  in  bed  and  continues  the 
use  of  the  hot  applications.  The  hot  applications  are 
used  regularly,  except  in  cases  with  recent  hemorrhage. 

During  the  fourth  week  the  patient  begins  to  be  up 
and  about  on  the  convalescent  gastric  diets. 

Sippy's  Treatment  for  Peptic  Ulcer 

The  patients  are  put  to  bed  for  from  three  to  four 
weeks  and  then  gradually  allowed  up,  but  can  do  no 
real  work  for  a  period  of  seven  or  eight  weeks  in  all. 
Each  morning,  one-half  hour  before  the  first  feeding,  a 
dram  (4  gm.)  of  subnitrate  of  bismuth  is  given  in  a  little 
water.  Feedings  are  given  every  hour  from  7  a.  m.  to 
7  p.  M.  consisting  of  equal  parts  of  milk  and  cream,  a 
total  of  I  to  3  ounces  (30-90  c.c).  Although  acidity 
is  best  controlled  by  hourly  feedings,  some  cases  do 
well  on  a  two,  three  or  four  hourly  schedule.  Half 
way  between  each  feeding  a  powder,  consisting  of  10 
grains  (.6  gm.)  each  of  calcined  magnesia  and  soda 
bicarbonate  is  given  alternating  with  another  powder 
of  10  grains  (.6  gm.)  bismuth  and  20  to  30  grains 
(1.3-2  gm.)  soda  bicarbonate.  The  magnesia  is  used 
as  often  as  possible,  as  it  has  the  highest  neutralizing 
power  for  free  hydrochloric  acid.  If  diarrhea  develops, 
use  less  of  the  magnesia  powder  and  more  of  the  other. 

After  two  or  three  days,  soft  eggs  and  well  cooked, 
fine  cereals  are  added,  so  that  at  the  end  of  ten  days 
patients  are  receiving  milk  and  cream  mixture  every 


GASTRIC   DIETS  63 

hour  7  A.  M.  to  7  P.  M.,  three  soft  boiled  eggs,  one 
at  a  time,  9  ounces  (270  gm.)  of  cereal,  3  ounces  (90 
gm.)  given  at  each  of  three  feedings.  The  extras  are 
evenly  spaced  throughout  the  day  but  the  total  amount 
of  each  feeding  should  not  exceed  6  ounces  (180  gm.). 
To  insure  the  success  of  this  treatment  absolute  accurate 
control  of  the  acidity  must  be  maintained  throughout 
the  twenty-four  hours.  This  is  accomplished  by  testing 
the  gastric  contents  frequently,  early  in  the  treatment, 
by  the  stomach  tube  or  duodenal  tube  as  follows. 

The  first  day  or  two  the  tube  is  passed  occasionally 
to  determine  the  presence  of  free  Hcl;  if  present  in  the 
stomach  contents,  the  alkali  powders  must  be  increased 
as  the  treatment  aims  to  keep  the  free  Hcl  absolutely 
neutralized.  After  the  first  few  days  this  need  only  be 
done  two  or  three  times  a  week.  It  is  necessary  to  be 
sure  that  the  stomach  does  not  contain  free  acid  during 
the  night,  and  it  is  necessary  to  give  two  or  three  alkali 
powders  between  7  and  10  p.  m.  to  make  sure  of  this. 
At  10  o'clock  the  tube  should  be  passed  and  any  hyper- 
acid secretion  removed.  If  necessary,  the  tube  should 
be  passed  for  the  first  few  days  two  or  three  times 
through  the  night.  After  the  first  few  days  this  is 
rarely  necessary,  the  last  emptying  being  done  at  10 
p.  M. 

In  the  diet,  cream  soups,  vegetable  purees,  or  soft 
foods,  such  as  jeUies,  custards  and  creams  may  be 


64  GASTRIC   DIETS 

added.     Farina,  cream  of  wheat  and  rice  cooked  to  a 
pulp  are  best. 

During  the  third  week  soft  toast,  crackers,  purees  of 
potato,  and  other  cream  soups  may  be  added.  In  the 
fourth  week,  the  milk  and  cream  may  be  made  23^ 
ounces  (75  c.c.)  at  each  feeding,  the  feedings  lengthened 
to  two  hours  or  after  three  weeks,  three  hourly  feedings 
are  given.  The  bismuth  is  continued  for  six  to  eight 
weeks  and  the  alkaline  powders  for  several  months 
between  feedings.  For  a  year  or  more  only  soft 
unirritating  foods  should  be  taken. 

Modified  Diet  for  Peptic  Ulcer 

The  essential  features  of  both  the  von  Leube  and 
Sippy  methods  are  combined,  and  one  uses  peptonized 
milk  (peptonized  two  hours)  instead  of  the  milk-cream 
mixture  as  recommended  by  Sippy.  The  alkaline 
mixtures  are  used  half  way  between  feedings  and  two  or 
three  times  at  hour  intervals  after  the  7  p.  m.  feeding. 

This  combined  method  reproduces  medically  the 
conditions  that  are  sought  by  operation,  namely  a  con- 
tinued greatly  reduced  gastric  acidity,  and  even  more, 
real  alkalinity  of  gastric  contents,  and  a  rapid  emptying 
of  the  stomach;  as  Cannon  has  shown  that  fully  pep- 
tonized milk  leaves  the  stomach  exceedingly  rapidly. 

The  details  of  this  method  are  as  follows: 

The  patient  is  kept  in  bed  for  three  weeks  and  the  hot 
pad  applied  as  in  the  von  Leube  routine.     The  continu- 


GASTRIC   DIETS  65 

ous  Murphy  drip  of  2  per  cent,  glucose  solution  is  also 
used,  but  nothing  allowed  by  mouth  for  three  days. 
Mouth  washes  are  used  several  times  a  day.  Feedings 
are  begun  the  fourth  day,  consisting  of  2  ounces  (60  c.c.) 
of  fully  peptonized  milk  every  hour  or  two  hours  from  7 
A.  M.  to  7  P.  M.  Half  way  between  feedings  the  alkaline 
mixture  is  given  in  2  ounces  (60  c.c.)  of  water  as 
recommended  by  Sippy.  Each  day  the  milk  is  in- 
creased I  ounce  (30  c.c),  until  4  ounces  (120  c.c.)  are 
taken  every  hour,  or  8  ounces  (240  c.c.)  every  two 
hours,  depending  on  the  needs  of  the  individual  case, 
i.e.,  some  do  best  on  hourly  feedings;  some  on  two  hourly 
nourishment.  The  water  allowance  is  not  increased  to 
over  3  or  4  ounces  (90-120  c.c.)  with  the  contained 
alkali.  After  eight  days  of  feeding,  a  tablespoonful  of 
well -cooked  farina  is  allowed  at  first  twice  a  day  with 
the  milk  feedings  which  are  kept  up  continuously.  The 
tenth  day  farina,  cream  of  wheat  or  wheatena  are 
allowed  with  three  of  the  milk  feedings.  The  twelfth 
day  the  cereal  is  increased  to  two  tablespoons,  and  a 
small  sprinkling  of  powdered  sugar  is  allowed.  The 
fifteenth  day  four  soft  feedings  are  allowed  evenly 
spaced  throughout  the  day,  milk-toast  being  used  once. 
The  seventeenth  day  a  soft  egg  is  allowed,  or  custard. 
After  three  weeks  the  feedings  are  arranged  so  as  to  give 
three  soft  meals  at  8,  i  and  6.30  with  a  mid-feeding  at 
n  A.  M.  and  4  p.  m.  of  milk  with  custard,  junket,  or  cream 
cheese  sandwich.    In  the  fourth  week  creamed  fresh 


66  GASTRIC  DIETS 

cod  or  halibut  are  added,  cream  and  puree  soups, 
mashed  potato,  well-cooked  rice.  From  the  end  of  the 
third  week  the  peptonization  of  the  milk  is  reduced 
fifteen  minutes  a  day  until  plain  milk  is  taken,  but  al- 
ways scalded.  During  the  entire  treatment  the  alkaline 
mixtures  are  given  in  sufficient  amount  to  maintain  as 
nearly  as  possible  a  continuously  alkaline  gastric  con- 
tents, testing  the  contents  by  passing  a  small  stomach 
tube  or  a  duodenal  tube  into  the  stomach,  and  emptying 
the  stomach  at  bedtime  if  there  is  any  secretion,  as 
recommended  in  Sippy's  method. 

Diet  for  Ambulatory  Cases  of  Peptic  Ulcer 

The  dietetic  treatment  of  ambulatory  cases  of 
gastric  or  duodenal  ulceration  has  a  very  distinct 
place  in  therapeutics,  for  many  of  these  cases  are 
apparently  well,  except  for  the  characteristic  epigastric 
pain  which  comes  on  at  varying  times  after  meals,  and 
refuse  the  suggestion  of  taking  an  ulcer  "cure,"  as 
they  will  not  give  the  necessary  time.  These  cases  are 
often  surprisingly  helped  if  they  are  put  on  a  diet 
for  two  full  weeks  of  milk,  soft-boiled  eggs  (one  to  two 
minutes),  and  cream,  given  somewhat  as  follows: 

At  8  A.  M.,  I  p.  M.,  and  7  p.  m.:  2  glasses  of  milk 
(and  cream) ;  2  soft-boiled  eggs. 

At  II  A.  M.,  and  4  p.  m.,  i}^  glasses  of  milk  and 
cream. 


GASTRIC  DIETS  •  67 

This  gives:  Milk,  1665  c.c.  (56  oz.);  cream,  400  c.c. 
(13  oz.) ;  6  eggs. 

Protein,  105  gm.  (sH  oz.);  fat,  177  gm.  (6  oz.); 
carbohydrate,  85  gm.  (3  oz.) ;  calories,  2400. 

Before  breakfast  a  dram  (4  gm.)  of  subnitrate  of 
bismuth  is  given  in  an  ounce  of  water.  One-half 
hour  after  the  three  principal  meals  }i-i  dram  (2- 
4  gm.)  of  the  following  powder,  equal  parts  of  bismuth 
subnitrate,  soda  bicarbonate  and  calcined  magnesia 
is  given  in  4  ounces  (120  c.c.)  of  water.  The  mag- 
nesia may  be  reduced  and  an  equal  added  amount  of 
soda  given  if  the  bowels  are  made  too  active  by  the 
magnesia.  One-half  hour  after  the  11  A.  M.  and  4 
p.  M.  feedings,  one  teaspoonful  of  bicarbonate  of  soda 
is  given  in  3^^  glass  of  water.  At  night  after  the  7 
p.  M.  feeding,  the  magnesia  mixture  is  given  at  7.45  and 
a  teaspoonful  of  soda  at  8.45  p.  m.  and  9.45  P.  m., 
each  in  a  half  glass  of  water.  After  ten  days  of  this 
diet  soft  foods  are  allowed  as  in  the  von  Leube  diet. 

Duodenal  Feeding 

Introduction  of  the  Duodenal  Tube. — The  tube  is 
put  in  the  patient's  mouth  and  a  swallow  of  water 
given  to  facilitate  its  descent.  When  it  is  apparently 
in  the  stomach,  the  patient  lies  on  the  right  side  and 
enough  of  the  tube  allowed  to  go  down  so  it  will  gravi- 
tate into  the  duodenum.  The  time  it  takes  the  tube 
to  reach  the  duodenum  varies  from  ten  minutes  to 


68  GASTRIC  DIETS 

three  hours,  usually,  however,  within  an  hour  or  two. 
If  fluid  is  aspirated  from  time  to  time  the  position 
of  the  tube  can  be  determined,  acid  fluid  coming  from 
the  stomach,  alkaline,  and  particularly  bile-stained 
fluid,  from  the  duodenum.  When  once  in  the  duo- 
denum, the  tube  may  be  left  in  throughout  the  period 
of  feeding,  up  to  ten  to  fifteen  days. 

Einhorn  recommends  feeding  7  to  8  ounces 
(210-240  c.c.)  milk,  one  egg,  and  a  tablespoonful  of 
lactose.  Diarrhea  may  follow  the  use  of  lactose 
which  can  then  be  omitted.  Butter,  1-2  drams, 
(4-8  gm.)  may  be  added  to  each  feeding.  Gruels 
may  be  used  if  strained  and  free  from  lumps.  The 
feedings,  are  given  every  two  hours  during  the  day  or 
eight  feedings  in  all,  and  must  be  given  very  slowly 
as  overdistension  of  the  duodenum  causes  pain.  After 
feeding,  fresh  water  should  be  run  through  the  tube 
to  clean  it  out.  This  should  be  followed  by  air  so  the 
tube  shall  be  left  empty. 

Duodenal  Feeding  Diet.    (Einhorn) 

7.30  A.  M.  Oatmeal  gruel 180  c.c.  (6  oz.) 

One  egg 

Butter 15  gm.  (>^  oz.) 

Lactose 15  gm.  m  oz.) 

9.30  A.  M.  Pea  soup 180  c.c.  (6  oz.) 

One  egg 

Butter 15  gm.  {}4  oz.) 

Lactose 15  gm.  (>^  oz.) 


GASTRIC  DIETS  69 

11.30  A.  M.  Same  as  at  9.30  a.  m. 
1.30  A.  M.  Bouillon 180  c.c.  (6  oz.) 

One  egg 
3.30  p.  M.  Oatmeal  gruel 180  c.c.  (6  oz.) 

Butter 15  gm.  {}^  oz.) 

One  egg 

Lactose 15  gm.  {}i  oz.) 

5.30  p.  M.  Same  as  at  9.30  a.  m. 

9.30  p.  M.  Bouillon 180  c.c.  (6  oz.) 

One  egg 

Total  amount:  Calories 

Oatmeal  gruel 360  c.c.  (12  oz.)  1476 

Eggs 8  1352 

Pea  soup 720  c.c.  (24  oz.)    384 

Lactose 90  gm.  (  3  oz.)    369 

Bouillon 360  c.c.  (12  oz.)      39 

Butter 90  gm.  (  3  oz.)    715 

4335 

Gastro-enterostomy  Diet! 

This  is  applicable  to  esophageal  cases,  stomach  cases, 
such  as  partial  or  complete  gastectomy,  excision  of 
ulcer,  pyloroplasty,  gastro-enterostomy,  and  upper 
intestinal  procedures  such  as  transduodenal  operation, 
jejunal  resection  and  resection  of  upper  ileum, 
ist  Day:  Water,  i  oz.  (30  c.c.)  q.  3^^  hr. 

» A.  V.  S.  Lambert. 


70  GASTRIC   DIETS 

2d  Day:  Water,  3  02.(90  c.c.)  q.  2  hrs.  alt.  with  albu- 
min water,  2  oz.  (60  c.c.)  q.  2  hrs. 
3d  Day:  Water,  alb. -water  and  broth  in  3  oz.  (90  c.c.) 

amts.     Feedings  q.  i  hr. 
4th  Day:  Increase  3d  day  diet  to  4  oz.  (120  c.c.)  feedings. 
5th  Day:  Fluids,  4  oz.  (120  c.c.)  q.  2  hrs.     Milk  not 

included. 

Martin's  milk  4  oz.  (120  c.c.)  b.  d. 

Gruel,  4  oz.  (120  c.c)  b.  d. 

Scraped  beef  sandwich  b.  d. 

Fl.  ext.  cascara  t.  i.  d.,  s.  o.  s. 
6th  Day:  Allow   also   coddled   egg   b.    d.    and   milk, 

4  oz,  (120  c.c.)  t.  i.  d. 
7th  Day:  Milk,  6  oz.  (180  c.c.)  t.  i.  d.     Milk-toast  b.  d. 

Minced   chicken,  baked  potato  and  puree 

vegetable. 
8th  Day:  Toast  and  bread  and  butter. 
9th  Day:  Finely  cut  meat. 
Followed  by  limited  regulated  diet  for  two  weeks. 

Gastric  Intolerance  Diet 

Used  in  cases  of  persistent  vomiting 

Chloroform  water  (strictly  fresh) . .  .dram  i       4  c.c. 

Peptonized  milk  (five  minutes  later)  .oz.  3^^       15  c.c. 
Repeat  q.  i  h.  for  four  doses 
If  not  vomiting  advance  to 

Chloroform  water dram  i       4  c.c. 

Peptonized  milk  (five  minutes  later)  .oz.  i         30  c.c. 


GASTRIC  DIETS  7 1 

Repeat  q.  i  h.  for  four  doses 
If  not  vomiting  advance  to 

Peptonized  milk  alone i  oz.        30  c.c. 

Repeat  for  four  doses  q.  i  h. 
If  still  not  vomiting  advance  to 

Peptonized  milk 2  oz,        60  c.c. 

Repeat  q.  i  h.  for  four  doses 

Advance  then  at  discretion  of  doctor  or  nurse  to  more 

peptonized  milk,  full  fluids  or  soft  diet. 

Diet  Useful  in  Gastric  Hyperacidity 

May  take: 

Raw  oysters. 

Soups :  Cream  or  puree  (except  tomato) . 

Fish:  Fresh    cod,    halibut,    bass,    boiled,   with   cream 

sauce  or  broiled. 
Meat:  Beef  well  done  (without  gristle,  fat,  or  gravy), 

chicken,    turkey,   guinea-hen,   lamb    (without   fat), 

once  daily. 
Vegetables:  All  soft-boiled  green   vegetables,   except 

cabbage,    cauliflower,    brussel   sprouts,    or    turnips. 

Baked    white    potato    may    be    used  moderately. 

Rice  or  macaroni. 

Cheese:  Any  mild  variety,  but  better  without  this  at 

first. 
Desserts:  Cream  and  egg  desserts  of  all  sorts,  e.g., 

blanc     mange,    Bavarian    cream,    floating    island, 

cup  custard,  junket,  soft  rice  or  bread  puddings. 


72  GASTRIC  DIETS 

Gelatin  desserts  made  with  little  flavoring.  Very- 
little  sugar  used  in  all  desserts.  Fruit,  none,  except 
when  constipation  is  a  marked  feature,  then  stewed 
soft  fruits  may  be  taken  in  good  amount,  but  must 
be  cooked  with  very  little  sugar  and  are  best  taken 
with  or  after  a  meal,  never  before.  Cream  may 
usually  be  freely  used. 

Bread:  Toast,  stale  bread,  roll.  (Fresh  butter  or 
salt  butter  freshened  by  working  it  over  in  fresh 
water.) 

Drinks:  Weak  tea,  cocoa,  water,  and  milk. 

Cereals:  Fine-grained  varieties,  well  cooked. 

Eggs :  In  all  forms  except  fried. 

Foods  to  he  avoided: 

All  sour,  spiced,  or  peppery  foods,  condiments,  salt 
foods,  chow-chow,  etc.     Sweets,  fried  foods. 

Very  hot  or  very  cold  foods  or  drinks. 

Rough  hard  substances,  such  as  seeds,  skins  of  fruit 
or  vegetables,  corn,  uncooked  vegetables. 

Coffee,  wines,  liquors,  beer. 

Hot  breads,  pies,  cakes,  syrups,  etc. 

Convalescent  Gastric  Diets,  No.  I^ 

Breakfast:  Boiled  milk  with  cocoa  or  coJffee. 

Any  cereal,  strained,  with  cream. 

Soft  toast,  buttered. 
II  A.  M.:      Glass  of  milk. 

»  T.  C.  Janeway. 


GASTRIC  DIETS 


73 


Dinner: 


4.  p.  M. 

Supper: 


9.30  p.  M. 


Puree  of  potatoes,  peas,  or  beans  with 
toast  soaked  in  it,  or  boiled  rice,  with 
milk  or  cream. 

Junket  or  custard,  or  jelly  or  tapioca 
pudding. 

Glass  of  milk  with  beaten  egg  in  it. 

2  soft-boiled  eggs. 

Soft  toast. 

Glass  of  milk. 

Glass  of  milk,  with  beaten  egg  in  it. 


Convalescent  Gastric  Diets,  No.  2^ 

Breakfast:  Boiled  milk,  with  a  little  coffee  or  cocoa. 
Any  cereal,  strained,  with  cream 
Dry  toast,  buttered. 
I  egg. 
II  A.  M.:      Glass  of  malted  milk. 
Lunch:         2  soft-boiled  or  scrambled  eggs,  or  fresh 
boiled  fish  in  place  of  eggs. 
A  little  broiled   bacon   (eating   the   fat 

and  not  the  lean.) 
Toast  and  milk. 
Dinner:       Puree    of   potatoes,    rice,   barley,  peas, 
asparagus,  celery,  or  beans. 
Buttered  toast. 

Rare  beefsteak  broiled,   or   lamb   chop 
broiled,  roast  beef  or  lamb. 

^T.  C.  Janeway. 


74  GASTRIC  DIETS 

Roast  or  broiled  chicken  or  minced 
chicken,  with  well-cooked  rice  or  a 
well-baked  potato  with  butter. 

Junket  or  custard,  jelly  or  tapioca  pud- 
ding. 
10.30  P.  M. :  Glass  of  milk  with  lime-water. 

Comments  on  Gastric  Diets 
The  dietary  treatment  of  actue  peptic  ulcer,  gastric  or 
duodenal,  is  exceedingly  satisfactory,  and,  if  persisted 
in,  is  usually  successful  in  producing  a  cure.  The 
tendency  of  the  acute  ulcer  is  to  heal  if  given  the  oppor- 
tunity, and  this  fact,  no  doubt,  accounts  for  the  many 
forms  of  dietary  treatment  that  have  been  devised,  any 
one  of  them  being  fairly  successful,  if  given  carefully. 
On  the  other  hand,  the  chronic  ulcer  is  very  slow  to  heal 
and  requires  great  care  and  persistance  in  treatment,  if 
favorable  results  are  to  be  obtained.  While  the  Len- 
hartz  diet  might  do  well  for  the  acute  ulcer,  it  does  not 
succeed  so  well  in  the  chronic  cases,  as  the  food  quanti- 
ties are  too  great  and  meat  is  added  too  early,  indi- 
gestion and  vomiting  often  being  produced,  so  that  the 
diet  has  to  be  either  modified  or  else  abandoned.  In 
either  acute  or  chronic  cases,  the  Lockwood  modification 
of  the  von  Leube  diet,  or  the  modified  (von  Leube- 
Sippy  method)  work  well  and  are  to  be  preferred  to  the 
Lenhartz.  An  absolute  rule  of  thumb  feeding  is  not 
desirable  as  most  cases  need  certain  individual  modifica- 
tions of  any  diet. 


GASTRIC  DIETS  75 

In  ulcer,  the  use  of  various  forms  of  rectal  feeding  often 
comes  up  for  discussion  but  at  best  these  are  of  little 
more  use  than  to  furnish  fluid  to  the  system  during 
the  period  of  mouth  starvation,  and  so  little  is  satis- 
factorily furnished  of  real  food  value  that  the  giving  of  a 
2  per  cent,  glucose  solution  continuously  during  the 
first  few  days  seems  to  be  all  that  is  needed.  If  given  as 
the  Murphy  drip,  30  drops  per  minute  for  twenty- 
four  hours,  13^^  quarts  (1500  c.c.)  are  supplied,  pre- 
venting absolutely  the  distressing  thrist  so  often  seen 
when  not  used.  The  addition  of  50  grains  (2.6  gm.) 
strontium  bromid  to  the  drip  helps  to  keep  the  patient 
quiet  and  comfortable.  Fully  peptonized  milk  may 
be  used  in  the  same  way,  or  even  stronger  glucose 
solutions,  but  the  latter  are  apt  to  cause  rectal 
irritation. 

The  Gastric  intolerance  diet  is  sometimes  useful  when 
there  is  great  gastric  irritability  from  one  or  another 
cause,  with  nausea  and  vomiting,  particularly  after 
surgical  anesthesia. 

The  diet  recommended  for  use  after  gastro-enteros- 
tomy  or  other  operations  on  the  upper  gastro-intestinal 
tract,  is  of  great  value,  as  formerly  too  little  attention 
was  paid  to  this  matter,  and  the  postoperative  cases 
were  fed  too  liberally  or  carelessly.  Some  clinicians 
go  even  more  slowly  than  this  diet  indicates,  and  prefer 
to  use  a  regular  ulcer  diet,  such  as  the  von  Leube,  but 
advancing  rather  more  rapidly. 


76  GASTRIC  DIETS 

The  dietetic  treatment  of  a  hyperacid  gastric  condi- 
tion, of  course,  depends  largely  upon  the  underlying 
cause  of  the  hyperacidity;  thus,  if  it  is  due  to  ulcer  of 
the  stomach  or  duodenum,  the  proper  diet  for  these 
conditions  is  indicated.  There  are  cases,  however,  in 
which  the  hyperacidity  is  a  symptom  of  indefinite  and 
apparently  of  mild  origin  in  which  a  modified  diet  is  of 
use. 

The  principle  upon  which  this  diet  is  constructed  is 
based  upon  the  fact  that  food  which  is  chemically, 
thermally,  or  mechanically  irritating,  or  which  stays  a 
long  time  in  the  stomach,  is  almost  sure  to  increase  the 
hyperacidity.  Hence,  these  things  should  be  omitted 
from  the  diet  and  only  bland  foods  used.  The  other 
underlying  principle  of  the  diet  is  that  it  should  be  of 
a  high  protein  value,  in  order  to  offer  a  large  amount  of 
this  element  to  combine  with  the  free  hydrochloric 
acid  which  is  in  excess  in  this  condition. 

The  protein  should  preferably  be  of  the  least  stimulat- 
ing variety,  hence  meat  is  allowed  only  in  small  amount. 
The  best  kind  of  animal  protein  being  that  contained  in 
eggs,  milk,  and  boiled  fish. 


GASTRIC  TEST  MEALS 

Ewald:  On  early  morning  fasting  stomach,   give 

White  bread  (no  crust) 40  gm.  (i}i  oz.) 

Clear  tea  or  water 400  c.c.  (6  oz.) 

No  butter,  no  sugar  or  milk. 
Express  one  hour  later. 

Leube: 

Clear  beef  soup 400  c.c.  (13^'^  oz.) 

Beefsteak 200  gm.  (6%  oz.) 

Bread 50  gm.  (1%  oz.) 

Water 200  c.c.  {6%  oz.) 

Express  six  hours  later, 

Riegel : 

I  bowl  mutton  broth 200  c.c.  (6%  oz.) 

Beefsteak 200  gm.  {6%  oz.) 

Mashed  potatoes 50  gm.  {1%  oz.) 

I  roll  or  piece  of  bread, 

I  glass  of  water 200  c.c.  {6%  oz.) 

Express  six  hours  later. 

Serial  Test  Meal 

The  Ewald  meal  may  be  used  or  one  pint  of  gruel 
made  of  strained  oatmeal   or  other   cereal  just  thin 

77 


78  GASTRIC   TEST   MEALS 

enough  to  be  aspirated  through  the  small  tube  ordinarily- 
used.  A  sample  of  the  gastric  contents  is  aspirated 
and  tested  chemically  at  }^,  i,  il^i,  2  and  23^^  hours 
after  taking  the  meal. 

Comments  on  Test  Meals 

The  Ewald  test  meal  is  almost  too  well  known  to 
need  any  word  of  explanation,  but  an  outline  of  its  use 
and  a  word  about  routine  in  gastric  diagnosis  may  not 
be  amiss. 

Patients  presenting  themselves  for  diagnosis  should 
be  told  to  take  their  usual  supper  or  dinner  the  night 
before  the  examination,  eating  with  the  meal  a  helping 
of  spinach  and  a  few  stewed  prunes  or  dried  raisins. 
These  are  all  easily  recognized  in  the  early  morning 
fasting  stomach  should  there  be  any  actual  retention. 
Nothing  must  be  taken  into  the  stomach  after  this 
meal  until  the  time  of  examination,  not  even  water 
after  10  p,  m.  The  following  morning  the  stomach-tube 
is  introduced,  and,  by  expression  and  the  use  of  a 
Politzer  bag  or  stiff  rubber  bulb,  an  attempt  made 
(without  the  addition  of  water)  to  obtain  any  possible 
gastric  contents.  Whatever  is  obtained  is  examined  for 
mucus,  free  hydrochloric  acid,  total  acidity,  blood,  and 
microscopically  for  leukocytes,  food  remnants,  and  bac- 
teria. After  this,  or  even  in  case  there  is  nothing  ob- 
tained from  the  fasting  stomach,  the  Ewald  test  meal 


GASTRIC   TEST   MEALS  79 

is  given  and  removed  one  hour  later  without  the  addi- 
tion of  water.* 

The  Riegel  meal  is  often  used  for  the  purpose  of  learn- 
ing what  sort  of  gastric  chemistry  goes  on  in  the  presence 
of  what  might  be  called  a  normal  mixed  meal.  At  times 
the  Ewald  meal  will  show  no  free  acid,  whereas  if  meat  is 
included  this  may  call  out  enough  acid,  if  possible,  to 
give  the  reaction  for  free  acid.  Still  another  reason  for 
giving  the  Riegel  meal  is  that  the  Ewald  meal  is  rather 
an  abnormal  meal  and  not  so  apt  to  call  out  the  full  or 


*  The  following  should  be  about  the  normal  limits  of  gastric  chem- 
istry after  the  Ewald  meal: 

Mucus. — None,  or  very  small  amount. 

Expressed. — Not  over  loo  to  125  c.c. 

Relation  of  Solids  to  Liquids. — i  to  2  or  i  to  3. 

Free  Hydrochloric  Acid. — 15  to  30  (reckoned  in  cubic  centimeters  of 
3^0  normal  potassium  hydrate). 

Combined  Acids. — 20  to  30. 

Total  Acidity. — 45  to  60  (reckoned  in  cubic  centimeters  of  potassium 
hydrate  solution). 

Organic  Acids. — Absent. 

Reaction  to  Dilute  Lugol's  Solution. — Mahogany  color  (blue  or 
purple,  indicating  poor  starch  digestion;  reddish  or  yellow,  good  starch 
digestion). 

Biuret  Reaction. — Normal,  a  purple  pink. 

Blood  Test. — No  reaction  or  very  faint. 

Microscopic  Examination. — Starch  grains  and  scattered  cell  detritus 
(no  noticeable  number  of  leukocytes,  bacteria,  or  sarcinse  should  be 
present). 

No  food  from  previous  day  should  be  present. 

For  the  interpretation  of  the  divergences  from  the  normal  finding 
one  is  referred  to  the  regular  text-books  on  Gastric  Diseases.  Any  food 
from  the  previous  supper  must  be  taken  as  an  indication  of  mechanical 
obstruction  at  the  pylorus,  or  possibly  an  extreme  degree  of  motor 
insufficiency. 


8o  GASTRIC   TEST  MEALS 

normally  balanced  secretion  that  the  more  normal  meal 
might. 

The  difference  between  the  result  of  the  examination 
of  this  meal  and  the  Ewald  are:  There  may  be  higher 
acid  values,  the  starch  should  be  better  digested,  and 
blood  reaction  be  present  from  the  meat.  Of  course, 
too,  the  microscopic  examination  shows  the  meat 
residue. 

This  meal  or  theLeube  may  be  given  to  test  the  motor 
efficiency  of  the  stomach,  as  there  should  be  nothing 
left  after  six  and  one-half  to  seven  hours'  digestion 
and  the  stomach  should  be  empty. 

The  serial  test  meal  is  being  largely  used  in  many 
cUnics.  The  expression  is  made  by  a  small  stomach 
tube  or  the  duodenal  tube,  the  latter  may  be  left  in 
situ  during  the  whole  period,  aspirating  enough  con- 
tents every  half  hour  to  test  chemically. 


DIETS  FOR  INTESTINAL  CONDTTIONS 
Anticonstipation  Diet»  No.  I 

(Hospital) 

6  A.  M. :       Fruit,  stewed  or  fresh. 
i}'^  glasses  of  hot  water. 
Breakfast:  Oatmeal,  molasses,  coffee,  bran  biscuits. 

I  egg,  baked  apple  or  prunes,  butter, 
lo  A.  M. :      2  glasses  of  water. 
Dinner:    Soup,  meat  or  fish,  all  vegetables,  salad 

and  oil,  brown  bread  and  butter,  any 

dessert,  fruit. 
4  p.  M.:       2  glasses  of  water. 
Supper.:    Fruit,  cereal,  brown  bread  or  bran  biscuits 

and  butter,  molasses. 
Bedtime:     Dried  figs,  prunes  or  dates,  i  glass  of 

water. 

Approximate  Food  Value  to  be  Given 

Protein  Carbohydrate  Fat  Calories 

Men.. .  .70  gm.  i2}i  oz.).  300  gm.  (10  oz.).     80  gm.  (2%  oz.).    2200 
Women .60  gm.  (2    oz.).    250  gm.  (8M  oz-)-    70  gm.  (2^  oz.).    1800 

^  Modified  from  Vanderbilt  Clinic  diet  lists. 
6  81 


82  DIETS  FOR  INTESTINAL   CONDITIONS 

Anticonstipation  Diet  No.  2 

On  rising  drink  a  glass  of  water,  one-third  to  one- 
half  grape  juice  or  two  glasses  of  plain  water. 

Breakfast. — Stewed  fruit  or  fresh  fruit.  Oatmeal  or 
Pettijohn  breakfast  food  (25  per  cent,  bran),  with 
cream  and  sugar,  white  or  brown;  or  cornmeal  mush 
with  molasses,  golden  drip  or  maple  sugar;  eggs  or 
bacon,  whole  wheat  bread  or  bran  bread  or  crackers 
with  fresh  butter,  if  it  is  obtainable  (one  eats  more 
butter  when  it  is  fresh  than  when  salted),  or  cooked 
bran  may  be  mixed  with  the  morning  dish  of  cereal. 

Midmorning. — Drink  a  glass  of  water  or  eat  some 
dried  fruit,  figs,  dates  or  Bordeaux  prunes,  or  fresh 
fruit  in  season. 

Luncheon  or  Supper. — Small  piece  of  meat  or  fish, 
two  green  vegetables,  whole  wheat  bread  and  fresh  but- 
ter, bran  bread  or  crackers,  fruit,  fresh  or  stewed. 
Prime  or  fig  pudding,  or  salad  with  oil  dressing. 

Dinner. — Grapefruit,  vegetable  soup,  entree  of  fish 
or  egg  with  caper  sauce  or  plain.  Small  piece  of  fowl 
or  red  meat  with  fat.  Two  or  more  green  vege- 
tables, taken  in  double  quantity  and  cooked  with  but- 
ter or  oil,  unless  it  is  necessary  to  keep  the  weight 
down.  Salad  of  celery  and  fruit  or  lettuce  and  other 
vegetables  with  ship  biscuit  or  bran  cracker,  cold- 
slaw,  olives,  radishes,  dessert — a  fruit  pudding,  fresh 
fruit,  stewed  fruit,  figs,  nuts,  raisins. 

Bedtime. — Two  figs,  prunes  or  several  dates. 


DIETS   FOR  INTESTINAL   CONDITIONS  83 

Of  course  one  is  not  supposed  to  eat  all  the  articles 
mentioned  at  one  meal,  but  a  choice  made  for  each,  vary- 
ing it  as  to  fats  and  vegetables,  as  necessity  requires. 

Comments  on  Anticonstipation  Diets 

This  can  be  greatly  modified  in  detail  according  to 
the  patient's  financial  circumstances.  One  great  under- 
lying trouble  with  most  people  who  have  atonic  con- 
stipation (which  constitutes  by  far  the  most  common 
type)  is  that  the  colon  and  rectum  need  stimulation  by 
a  larger  food  residue  than  the  individual  normally  con- 
sumes, so  that  in  general  it  may  be  said  that  these  cases 
need  fruits,  cooked  or  raw,  and  green  vegetables  in 
double  or  treble  the  amount  the  normal  individual  does. 
It  is  only  by  constant  effort  and  encouragement  that 
patients  can  be  brought  to  do  this,  as  they  feel  they  are 
eating  too  much  food.  This  prejudice  can  be  removed 
when  they  are  told  of  the  really  slight  food  value  of  these 
articles  of  diet,  and  that  they  are  mainly  valuable  on 
account  of  their  bulk. 

Diet  in  Intestinal  Auto -intoxication  and  Indic  anuria. 

No.  i 

7.30  A.M.:    Cereal    prepared    with    water   or   milk. 
Rolls  and  fresh  butter. 
10.00  A.  M. :   Some  form  of  gruel  made  with  milk  or 
water. 


84  DIETS   FOR  INTESTINAL   CONDITIONS 

12.30  P.  M.:   One  or  two  yolks  of  eggs,  raw  or  boiled, 
macaroni,   rice,   farina    with  salt    and 
fresh    butter.      Farinaceous    pudding. 
Rolls   and    butter.     (Later    fruit    and 
soft  green  vegetables.) 
3.30  P.  M.:  The  same  as  at  10  a.  m. 
7.00  p.  M.:  Same  variety  as  at  12.30  p.  m. 
10.00  P.  M. :  Infusion  of  chamomile,  peppermint,  fennel, 
or  anise. 
After  eight  to  ten  days  of  this,  add  potatoes,  pur6e 
or  baked.     No  fluids  with  meals. 

Later  tea,  coffee,  cocoa,  vegetables,  and  fruits,  may 
be  added  in  the  order  named  with  a  little  meat,  first  at 
one  and  then  at  two  meals,  watching  the  effect  on  the 
urine. 

Diet  in  Intestinal  Auto -intoxication  and  Indic  anuria, 

No.  2 

Early  morning,  one-third  to  one-half  glass  of  grape 

fuice  with  equal  amount  of  water. 

Breakfast:  Glass  of  milk  or  buttermilk  with  cereal 
and  cream  (tea  or  coffee  later).  Bread 
and  fresh  butter.    Fruit. 

Midmorning:  One-half  glass  of  buttermilk  and  slice  of 
bread. 

Dinner  or  Supper:  Cream  vegetable  soup  (made  with- 
out stock)  or  thickened  with  flour.  Yolk  of 
two  or  three  eggs  poached  or  scrambled; 


DIETS   FOR  INTESTINAL   CONDITIONS  85 

macaroni,  cream  cheese,  potato,  rice,  baked 
farina,  green  vegetables  (that  grow  above 
ground).  Glass  of  milk  or  buttermilk. 
Bread  and  fresh  butter.  Farinaceous  pud- 
ding with  fruit  sauce  or  stewed  figs,  prunes, 
apricots,  pears,  cherries  or  peaches. 

Midafternoon:   Cream  cheese  and  crackers. 

A.t  Bedtime:  One-half  to  one  glass  of  buttermilk  with 
two  or  three  toasted  crackers  and  several 
dates  or  figs. 

Comment  on  Diet  in  Intestinal  Auto -intoxication 

In  conditions  of  so-called  intestinal  auto-intoxication 
it  is  usually  necessary  to  reduce  the  protein  to  the 
lowest  possible  amount  as  so  many  cases  of  this  trouble 
are  accompanied  by  the  putrefaction  of  protein  with 
the  excessive  production  of  indol  and  skatol.  Of  the 
diets  useful  in  intestinal  auto-intoxication  and  indi- 
canuria  No.  i  is  the  most  drastic  and  is  usually  only 
necessary  for  a  few  days  after  which  No.  2  can  be  used, 
finally  working  toward  the  use  of  one  of  the  anti- 
constipation  diets  if  the  condition  is  accompanied  by 
constipation.  In  any  event,  colon  irrigations  should 
be  given  regularly  every  day,  every  other  day  or  twice 
a  week  as  the  severity  of  the  case  and  the  persistence 
of  the  symptoms  demand. 


86  DIETS  FOR  INTESTINAL  CONDITIONS 

Diarrhea 
acute  diarrhea 

It  seems  almost  uimecessary  to  discuss  this  condition 
from  a  dietetic  point  of  view,  as  the  principles  govern- 
ing the  feeding  of  such  cases  in  adults  seem  generally  so 
well  understood.  After  an  initial  purge  and  a  period  of 
digestive  rest  one  can  give  the  ordinary  fluid  diet  with- 
out milk,  consisting  of  broths,  egg-albumin  in  water 
flavored  with  orange-  or  lemon-juice,  and  thin  gruels, 
followed  later  by  thin  cereals,  scraped  meat,  and  toast. 
Fresh  milk  in  any  form  usually  does  not  agree,  and  is 
apt  to  increase  or  at  least  keep  up  the  diarrhea.  One 
should  not  be  afraid  of  a  generous  amount  of  starvation, 
as  physiologic  rest  to  the  bowel  is  often  all  that  is 
needed. 

CHRONIC  DIARRHEA 

Differing  from  acute  diarrhea  (where  the  cause  is 
practically  always  from  a  gross  dietetic  error)  the  causes 
of  chronic  diarrhea  (which  is  only  a  symptom)  are  numer- 
ous. In  order  to  treat  such  a  condition  successfully  one 
must  make  an  accurate  diagnosis,  otherwise  it  is  time 
and  energy  thrown  away.  One  case  in  point:  The 
chronic  diarrhea,  usually  associated  with  a  persistent 
gastric  achylia,  is,  for  the  most  part,  promptly  stopped 
by  merely  giving  dilute  hydrochloric  acid  regardless  of  a 
diet;  and  often  no  amount  of  dieting  of  any  description 
will  control  this  diarrhea  without  supplying  the  lack  of 
normal  acid.    Hence  one  sees  the  necessity  for  an 


DIETS   FOR  INTESTINAL  CONDITIONS  87 

accurate  diagnosis  preliminary  to  any  form  of 
treatment. 

There  are,  however,  numerous  cases  of  chronic 
diarrhea  when,  regardless  of  the  underlying  cause, 
there  is  the  need  of  a  diet  which  fulfils  the  following 
conditions: 

(i)  Non-stimulating  and  non-irritating. 

(2)  Easily  digested,  leaving  little  residue. 

(3)  Not  apt  to  ferment. 

(4)  As  astringent  as  possible. 

In  order  to  fulfil  these  conditions  the  articles  of  food 
may  be  divided  into  those  directly  useful,  those  to  be 
avoided,  and  those  possibly  allowable  in  certain  cases. 

Diet  in  Chronic  Diarrhea 

May  take: 

Raw  oysters  (soft  part). 

Clear  soups. 

Fish:  Any  soft,  white-meated,  non-oily  variety. 

Meat:  Beef,  lamb,  without  gristle,  chicken,  guinea- 
hen. 

Cereals.:  Farina,  cream  of  wheat,  grape-nuts,  shred- 
ded wheat,  wheatena,  flaked  rice,  puffed  wheat  or 
rice,  well-boiled  rice. 

Gruels:  Vermicelli. 

Bread:  Stale  bread,  toast,  zwieback,  toasted  crackers. 

Cheese:  Ripe,  American,  Canadian,  cream  or  cottage, 
pineapple. 


88  DIETS  FOR  INTESTINAL   CONDITIONS 

Desserts:  Gelatin  desserts  made  with  little  sugar, 
farina  pudding  or  almost  any  cereal  pudding,  sim- 
ple cake  at  times  {e.g.,  sponge),  blanc  mange. 

Drinks:  Water,  tea,  black  coffee,  cocoa,  claret,  dry 
sherry.  Burgundy,  whisky  or  brandy,  and  water. 

To  be  avoided: 

Milk  (?):  Some  cases  can  take  it  boiled  or  skimmed. 

Tough  or  oily  l&sh,  clams,  etc. 

Pork,  veal,  ham,  duck,  goose. 

Pickles,  condiments,  salads,  olives,  etc. 

Green  vegetables,  salads,  fruits,  fresh  or  stewed. 

Hot  breads,  pies,  sweets  of  all  kinds. 

Sweet  wines. 

Articles  allowable  in  certain  cases: 

Malted  milk  may  often  be  used  on  cereals,  and  is 
better  borne  than  fresh  milk.     Fresh  milk  boiled. 

Turkey,  bacon  (crisp),  koumiss,  zoolak,  baked  white 
potato.  Eggs — boiled,  baked,  poached,  omelette, 
scrambled. 

Baked  hubbard  squash,  well-stewed  celery,  creamed 
spinach,  small  boiled  onions.  Boiled  peas  or  lima 
beans  put  through  a  colander,  without  skins. 

Constipating  Diet 

Applicable  to  resection  of  lower  ileum,  colon,  sigmoid 
and  rectum.  First  four  days  apphcable  to  hemor- 
rhoids and  fistula  in  ano  cases.  In  other  cases  con- 
tinue fluids  without  milk  until  fifth  day. 


DIETS   FOR   INTESTINAL   CONDITIONS  89 

ist  Day:    Water 
2d  Day:  Fluids  without  milk. 

3d  Day:    Breakfast:  Farina    with    cream,    soft    egg, 
small  slice  toast,  coffee. 
Dinner:       Clear  soup,  small  piece  of  fish  or 
lean  meat  or  4  raw  oysters,  one 
slice  of  bread  and  butter,  gelatin, 
desserts. 
Supper :       Soft  egg  on  toast,  tea. 
4th  Day:    Add  honey  or  molasses.     (In  other  than 
hemorrhoids  and  fistula  do  not  add  until  two 
days  before  bowel  action  is  desired.) 
Schmidt's  Intestinal  Test  Diet^ 
In  the  morning,  0.5  liter  (16  oz.)  milk,  or,  if  milk  does 
not  agree,  0.5  liter  (16  oz.)  cocoa,  prepared  from  20  gm. 
(%  oz.)  cocoa  powder,  10  gm.  {}i  oz.)  sugar,  400  c.c. 
(13  oz.)  water,  and  100  c.c.  (3%  oz.)  milk. 

In  the  forenoon,  0.5  liter  (16  oz.)  oatmeal  gruel,  made 
from  40  gm.  {i}4  oz.)  oatmeal,  10  gm.  {}i  oz.)  butter, 
200  c.c.  (63^^  oz.)  milk,  300  c.c.  (10  oz.)  water,  i  egg, 
strained. 

At  noon,  125  gm.  (4  oz.)  chopped  beef  (raw  weight), 
broiled  rare  with  20  gm.  {%  oz.)  of  butter,  so  that  the 
interior  will  still  remain  raw. 

To  this  add  250  gm.  (8  oz.)  potato  broth,  made  of 
190  gm.  {6}yi  oz.)  mashed  potatoes,  100  c.c.  {^}^i  oz.) 
milk,  and  10  gm.  (M  oz.)  butter. 

*  Schmidt,  The  Test  Diet  in  Intestinal  Diseases. 


go 


DIETS   FOR   INTESTINAL   CONDITIONS 


In  the  afternoon  as  in  the  morning. 
In  the  evening  as  in  the  forenoon. 
This  diet  consists  of: 

Milk 1.5  liters  {i}4  qt.) 

Zwieback 100  gm.       (33^1  oz.) 

Eggs 2 

Butter 50  gm. 

Beef 125  gm. 

Potatoes 190  gm. 

Oatmeal  (gruel) 80  gm. 

This  contains  protein  102  gm.  (33^^  oz.);  fat,  in  gm. 
(4  oz.) ;  carbohydrates,  191  gm.  {6}i  oz.) ;  calories,  2234. 

A  good  many  patients,  especially  women,  cannot 
take  so  large  an  amount  of  food  as  called  for  in  the 
Schmidt  diet,  and  the  following  modification  has  been 
planned  to  meet  such  cases. 


(i^  oz.) 
(4  oz.) 
(6M  oz.) 
(2%  oz.) 


MODIFIED 

SCHMIDT  DIET 

p 

F 

C 

Cal. 

Oatmeal 

Rice 

.  i6sgm.  (  S>^oz.) 
90  gm.  (  3      oz.) 

.  1500  c.c.  (so  oz.) 
40  gm.  (  iHoz.) 

.  120  gm.  (  4  oz.) 
6s  gm.  (  2      oz.) 

4.4 

2.4 

49- S 

0.6 

13.1 

17. 1 

0.8 

0.8 

60.0 

340 

2.4 
4-7 

18.2 
21 .0 

67. s 
80.0 

100 

Milk 

Butter 

Bread 

Chopped  meat.. 

1080 
318 
400 
100 

Protein,  87.1  gm.  (3  oz.);  Fat,  102.7  gm.  (3^  oz.);  Carbohydrates,  187.7  gm. 
(6  oz.) ;  Calories,  3088. 


Breakfast  Dinner  Supper 

Oatmeal,  i6s  gm.  (sH  oz.)  Meat,  6s  gm.  (2  oz.)  Rice,  90gm.  (3  oz.) 
Milk,  250 c.c.  (3  oz.)  Bread,  40gm.  (ij^  oz.)  Bread,  40gm.  (ij^  oz.) 
Bread  40gm.  (iKoz-)  Milk,  250  gm.  (8  oz.)  Butter,  isgm.  (  H  oz.) 
Butter,  IS  gm.  (  H  oz.)  Butter,  10  gm.  (  J^  oz.)  Milk.  2S0  c.c.  (8  oz.) 
At  10,  3  and  9  o'clock,  250  c.c.  milk. 


diets  for  intestinal  conditions  9 1 

Comments  on  Schmidt's  Intestinal  Test  Diet 

Schmidt's  intestinal  test  diet  is  a  convenient  and  uni- 
form diet  for  testing  the  intestinal  functions,  and  gives 
as  a  starting-point  a  feces  of  uniform  composition.  In 
Schmidt's  words,  "such  a  test  diet  must  be  one  which 
can  be  taken  equally  well  by  healthy  people  as  well  as 
those  suffering  from  an  intestinal  disorder;  it  must  be 
free,  but  not  absolutely  free,  from  waste  matter,  in  order 
that  the  stimulus  ordinarily  furnished  by  the  ingesta 
should  not  be  completely,  absent;  it  must  be  capable  of 
supplying,  at  least,  the  minimum  of  calories  required  by 
the  body  (at  rest),  and  must  contain  the  three  chief 
groups  of  food  stuffs  in  proportionate  relation  to  each 
other;  finally,  it  must  be  of  simple  composition,  easy 
to  make,  and  uniformly  prepared."  While  this  is  not 
the  only  diet  conceivable  for  such  a  purpose,  there  is  a 
great  advantage  in  the  universal  use  of  a  particular  diet 
for  testing  intestinal  functions,  just  as  we  use  standard 
diets  for  testing  the  gastric  functions,  and  it  is  of  a 
definite  composition  and  the  result  of  its  use  in  many 
cases  can  be  correlated. 


DIABETIC  DIETS 
No.  I.   Diet  for  a  Fast  Day 

Breakfast:  Cup  of  coffee,   200  c.c.   {6}i  oz.)  (sac- 
charin).    No  milk  or  sugar. 
Thrice  cooked^  5   per   cent,   vegetables, 
200   gm.    {6^    OZ-,    e.g.,   string    beans, 
spinach,  cauliflower,  etc.,  vinegar,  q.  s. 

Mid  A.M. :   Salt-poor  broth,  200  c.c.  (6}i  oz.) . 


Luncheon:  Salt-poor  broth,  200  c.c.  (63^^  oz.).  Cup 
of  tea  or  coffee,  200  c.c.  (63^^  oz.)  (or 
more).  Thrice  cooked  5  percent,  vege- 
tables, 200  gm.  {6}^  oz.).  Vinegar  q.  s. 
Whisky,  30  c.c.  (i  oz.)  if  desired. 

Supper:  Same  as  lunieheon,  using  variety  of  vege- 
tables. 

Bedtime:    Salt-poor  broth. 
Water  ad  libitum. 

In  certain  cases  a  total  of  800  gm.  (26  oz.) 
of  thrice  cooked  5  per  cent,  vegetables  is 
allowed. 


^  Thrice  cooked  means  boiled  in  three  separate  waters  to  remove 
practically  all  carbohydrates. 

92 


DIABETIC  DIETS  93 

No.  2.    Standard  Strict  Diet.    (Geyelin) 

Diet  contains   15   gm.   carbohydrate,   30   gm.   fat, 
30  gm.  protein.^ 
Breakfast:  2  eggs. 

1  cup  of  coffee  (200  c.c.)  63^  oz.  and  sac- 
charin.    No  cream. 

Luncheon:  Tomatoes  (fresh)  (200  gm.)  63^^  oz. 

(7.8  gm,  (117  grains)  carbohydrate.) 

Broth  (200  c.c.)  63^  oz. 
2  P.M.:       I  white  of  egg. 
•  Broth  (200  c.c.)  6}'^  oz. 

Supper:      String  beans  (canned)  (200  c.c.)  6}-^  oz. 

(7.2  gm.  (108  grains)  carbohydrate.) 

Butter,  (7  gm.)  }i  oz. 

2  eggs. 

I  cup  of  tea — no  cream. 
Chicken  may  be  substituted  here  for  eggs — 71  gm. 
(105    grains)    would   be   necessary,    then   3    gm.    (45 
grains)  must  be  added  to  butter. 

When  necessary  200  (63^^  oz.)  to  300  c.c.  (10  oz.)  of 
broth  may  be  given  at  8  or  9  p.  m. 

Next  day  25  gm.  carbohydrate:  To  increase  this 
diet  10  gm.  (150  grains)  carbohydrate  without 
changing  fat  or  protein  appreciably  add  250  gm. 
(8  oz.)  of  cooked  beans,  given  at  lunch.  Calories, 
41. 
35  gm.:  To  increase  10  gm.  (150  grains)  more  carbo- 
^  Spoken  of  as  a  fifteen,  thirty,  thirty  diet. 


94  DIABETIC   DIETS 

hydrate  add  i8o  gm.  (6  oz.)  ol  (once  boiled)  cab- 
bage and  take  away  the  white  of  one  egg.  Add 
cabbage  to  2  p.  m.  feeding.    41  calories. 

45  gm.:  To  increase  10  gm.  more  add  250  gm.  (8  oz.) 
of  raw  or  canned  tomato,  add  this  to  breakfast. 
41  calories. 

55  gm.:  To  increase  10  gm.  (150  grains)  more  add 
180  gm.  (6  oz.)  more  cabbage.     41  calories. 
185  gm.  (6  oz.)  cabbage.     250  gm.  (8  oz.)  beans. 
All  salt  free. 

Protein 30  gm.  (i    oz.)  121.8  calories.  * 

Fat 30  gm.  (i    oz.)  276.2  calories. 

Carbohydrate. .  15  gm.  (3^^  oz.)    63.1  calories. 

46 1. 1  calories  for  15: 
30:  30.  diet. 
No.  3.    Alternate  Standard  Strict  Diet 
(15:30:30.) 

Breakfast:  Egg,  i. 

Cofifee,  I  cup,  200  c.c.  (63^^  oz.)  with  sac- 
charin.    No  milk. 
Dinner:       Steak,  lean  round,  75  gm.  {2}^  oz-)* 

Beans,  string,  132  gm.  (4^^^  oz.). 

Tomato,  canned,  127  gm.  (4  oz.). 

Butter,  10  gm.  (}i  oz.). 

Cup  of  tea,  200  c.c.  {6}/^  oz.). 
Supper:       Asparagus,  178  gm.  (6  oz.). 

Egg,  90  gm.  (3  oz.). 

Butter,  10  gm.  Q^i  oz.). 

Tea,  200  c.c.  {6}i  oz.). 


DIABETIC  DIETS 

Diet: 

30  P. 

30  F.      IS  ( 

Steak, 

75  gm.  {2},i  oz.) 

15.0 

1-5 

Beans, 

132  gm.  (43^  oz.) 

1.4 

0.1      5.0 

Tomato, 

127  gm.  (4      oz.) 

1-5 

0.2      5.1 

Asparagus, 

,  i78gm.  (6     oz.) 

2.5 

0.1       5.0 

Egg  (2), 

90  gm.  (3      oz.) 

II. 4 

II. 4 

Butter, 

20  gm.  m    oz.) 

17.0 

95 


P.31.8F.30.3C.1S.1 

No.  4.    Alternate  Standard  Strict  Diet 
(15:  30:  30.) 

Breakfast:  Egg,  y.  i. 

Egg  w.  2 

Butter  5  gm.  (i^^^  drams.) 

Tea  or  coffee  without  sugar  or  milk.     200 
c.c.  (63-^  oz.). 
Dinner:       Chicken,  100  gm.  (3^'^  oz.). 

Cauliflower,  no  gm.  (33^^  oz.). 

Tomato,  127  gm.  (4  oz.). 

Lettuce,  25  gm.  (i  oz.). 

Butter,  10  gm.  (3*^  oz.). 

Tea,  200  c.c.  (63^^  oz.). 
Supper:       Beans,  132  gm.  (43^^  oz.). 

Butter,  5  gm.  (13-^  drams). 

Tea  or  coffee  without  milk  or  sugar,  200 
c.c.  (63^^  oz.). 


Diet:  30  p.        30  F. 

Chicken,        ioogm.(33'^  oz.)     17.6         7.6 
Cauliflower,  iiogm.(3%  oz.)       0.9 


isC. 


0.5 


96 


DIABETIC   DIETS 


Tomato,         127  gm.  (4     oz.)  1.5  0.2         5.1 

Lettuce,  25  gm.  (i      oz.)  0.3  ...         0.7 

Beans,  132 gm.  (4>^oz.)  1.4  o.i         5.0 

Egg,  (i  y.,  w.  2)  8.8  5.7 

Butter,  2ogm. (^^  oz.)  ...  17.0 

P.30.5F.30.6  C.15.8 
Tea  or  coffee. 
Sample  Diabetic  Diets  of  Increasing  Strength 


Gm., 
Amt. 


Pro. 


Pat. 


CH. 


No.  5. 
Breakfast: 

Egg,  whites  (2) . . . 

Egg,  yolks  (2).... 

Grapefruit 

Dinner: 

Round  steak 

Beans 

Supper: 

Chicken 

Lettuce 

Tomatoes 

No.  6. 
Breakfast: 

Egg,  whites  (3)... 

Egg,  yolks  (3). . . . 
Dinner: 

Carrots 

Cream 

Steak  (round  lean) 

Beans 

Supper: 

Asparagus 

Cream 

Chicken 


5.6 

34 

100 

80 
130 

50 

25 

125 


6.2 

5-2 


17.0 
1-4 

8.8 

0.3 
I.I 


84 
51 

SO 

25 

130 
100 

178 

25 
60 


40.0 


9-3 
7-8 

0.5 

0.6 

27.6 

I.I 

2-5 

0.6 

10. s 


II. 4 

6.3 
0.1 

3-8 

0-5 
22.1 


17. 1 

0.2 

4-7 

10.2 

0.1 

0.1 
4-7 
4-5 


50 


50 


0.7 
4.8 


15-5 


4.6 
I.I 

3-8 

50 
I.I 


Diet 
Pro.  40,  Fat  20,  Co  H  15 


Calories  in  Pro.  164 .  o 
Calories  in  Fat  205 .  s 
Calories  in  Co  H    63 . 5 

433  o 


Diet 
Pro.  60,  Fat.40,  Co  H 15 


Calories  in  Pro.    248 .  o 

Calories  in  Fat     386. 8 

Calories  in  Co  H   63 . 9 

698.7 


DIABETIC  DIETS 


97 


Gms., 
amt. 


Pro. 


Fat 


CH. 


No.  7. 
Breakfast: 

Grapefruit. . . 

Salmon  (can) 
Dinner: 

Asparagus. . . 

Beets 

Steak  (round) 

Butter 

Supper: 

Lettuce 

Peas 

Cream  cheese 
(crown) — 

Chicken 


No.  8 
Breakfast: 

Grapefruit 

Egg,  whites  (2) 

Egg,  yolks  (2). 

Bread 

Dinner: 

Peas 

Steak  (round). 

Egg,  white  (i). 

Egg,  yolk(i).. 

Salmon 

Cream 

Supper: 

Beans 

Lettuce 

Cream  cheese.. 

Chicken 

Apple 


100 
100 

100 

75 
no 

9 

25 

100 

25 

100 


200 
S6 
34 
20 

100 
120 
28 
17 
55 
25 

100 
25 
25 

100 
90 


21.8 

1-5 
I.I 

234 


0.3 
3-6 

1-3 
17.6 


0.1 
0.1 
8.6 

7.2 


14-5 
7.6 


5-0 


2.8 
6.7 


0.7 
10.  o 

0.5 


Diet 
Pro.  70,  Fat  50,  Co  H  25 


Calories  in  pro.  289 . 4 
Calories  in  fat  468 . 7 
Calories  in  Co  H  105 . 3 


863.4 


70.6 


SO. 4 


25-7 


6.2 
5-2 
1.8 

3-6 
25-5 

31 

2.6 
II. 9 

0.6 

I.I 

03 

1-3 

17.6 

0.3 
81. 1 


Diet 
Pro.  80,  Fat  60,  Co  H  so 


II. 4 


0.2 
9.4 

5-7 
6.6 
4-7 

0.1 

145 
7.6 
0.4 

60.6 


3.8 
0.7 
0.5 

14.7 

50.8 


Calories  in  pro.  332 . 5 
Calories  in  fat  563 . 5 
Calories  in  Co  H  208. 2 

1104.3 


98 


DIABETIC  DIETS 


Foods  Arsanged  Approximately  According  to  Per  Cent,  of 
Carbohydrates  ^ 

Vegetables 


S  Per  cent. 

10  Per  cent. 

IS  Per  cent. 

20  Per  cent. 

Lettuce 

Cauliflower 

Onions 

Green  peas 

Potatoes 

Spinach 

Tomatoes 

Squash 

Artichokes 

Sheel  beans 

Sauerkraut 

Rhubarb 

Turnip 

Parsnips 

Baked  beans 

String  beans 

Egg  plant 

Carrots 

Canned  lima 

Green  corn 

Celery 

Leeks 

Okra 

beans 

Boiled  rice 

Asparagus 

Beet  greens 

Mushrooms 

Boiled 

Cucumbers 

Watercress 

Beets 

macaroni 

Brussels 

Cabbage 

sprouts 

Radishes 

Sorrel 

Pumpkin 

Endive 

Kohl-rabi 

Dandelions 

Broccoli 

Swiss  chard 

Vegetable 

Sea  kale 

marrow 

Fruits 


Ripe  olives 

Lemons 

Apples 

Plums 

(20  per  cent,  fat) 

Oranges 

Pears 

Bananas 

Grapefruit 

Cranberries 

Apricots 

Strawberries 

Blueberries 

Blackberries 

Cherries 

Gooseberries 

Currants 

Peaches 

Raspberries 

Pineapple 

Huckleberries 

Watermelon 

*  Joslin  Treatment  of  Diaoetes,  page  370,  ist  ed. 


DIABETIC   DIETS 

Nuts 


99 


Butternuts 

Brazil  nuts 

Almonds 

Peanuts 

Pignolias 

Black  walnuts 

Walnuts 

Miscellaneous:     unsweet- 

Hickory nuts 

(English) 

ened  and  spiced  pickles, 

Pecans 

Beechnuts 

40  per  cent. 

clams,    oysters,  scallops, 

Filberts 

Pistachios 

Chestnuts 

liver,  fish  roe. 

Pine  nuts 

Reckon  actually  available  carbohydrates  in  vegetables  of  5  per 
cent,  group  as  3  per  cent.,  of  10  per  cent,  group  as  6  per  cent. 

Comments  on  Diabetic  Diets 

The  older  method  of  dietary  cure  for  diabetes  melli- 
tus,  as  exemplified  by  the  Vienna  school,  has  given  way 
almost  completely  to  the  routine  first  advocated  by 
Allen.  The  essential  features  of  this  plan  of  treatment 
are  (i)  starvation  of  the  patients  until  they  become 
sugar  and  acid  free;  (2)  reduction  of  weight  below 
that  ordinarily  normal  for  that  individual  in  health; 
(3)  the  determination  of  the  individual's  protein,  fat 
and  carbohydrate  tolerance. 

The  starvation  may  be  relative  or  actual  but  usually 
the  former,  as  broths,  black  coffee,  tea,  whisky  and 
thrice  cooked  vegetables  are  allowed  and  in  some  cases 
a  weak  food  formula  of  carbohydrate  15  gm.,  fat  30  gm. 
protein  30  gm.  is  used.  The  fear  of  severe  ketonuria 
following  such  a  procedure  has  been  entirely  done  away 
with,  as  experience  has  shown  that  the  organic  acids 
and  the  sugar  usually  disappear  progressively  from  the 
urine.     When,  after  a  trial  of  a  few  days,  this  does  not 


lOO  DIABETIC   DIETS 

take  place  it  is  often  only  necessary  to  give  a  little  food 
for  a  day  or  two  and  then  withdraw  it,  after  which  the 
sugar  and  ketone  bodies  are  apt  to  clear  up. 

Allen  found  a  distinct  advantage  and  increased 
carbohydrate  tolerance  after  the  patients  lose  weight, 
and  often  when  they  start  later  to  reaccumulate  fat, 
sugar  may  again  appear  in  the  urine. 

The  method  of  using  Allen's  principles  of  diet,  as 
modified  by  Geyelin,  may  be  stated  as  follows,  for  while 
it  is  impossible  to  outline  in  detail  a  method  of  treatment 
which  will  apply  to  all  cases  of  diabetes,  the  following 
general  routine  is  the  one  most  commonly  used  in  the 
Presbyterian  Hospital. 

The  patient  is  placed  on  an  arbitrary  low-caloric  diet 
made  up  of  15  gm.  04  oz.)  carbohydrate,  30  gm.  (i  oz.) 
protein  and  30  gm.  (i  oz.)  fat.  He  is  kept  on  this  diet 
for  a  few  days  to  determine  what  effect  this  low-food 
intake  has  in  overcoming  glycosuria.  Low  as  this  food 
intake  is,  it  is  more  agreeable  to  the  patient  than  com- 
plete fasting.  If  after  a  period  of  from  one  to  four 
days,  the  glycosuria  is  not  decreasing  or  is  increasing,  a 
fast  is  immediately  instituted. 

On  a  fast  day  the  patient  is  given  the  following: 
Water,  coffee,  tea  and  thin  broth  in  definite  amounts, 
together  with  thrice  boiled  5  per  cent,  vegetables  and 
at  least  10  gm.  of  salt.  Whisky  is  given,  if  indicated, 
in  daily  doses  of  from  2  to  5  ounces.     (Diet  No.  i). 

As  soon  as  the  patient  is  free  from  sugar,  and  using  the 


DIABETIC  DIETS  lOI 

blood  sugar  as  a  rough  guide  of  future  food  tolerance, 
a  diet  of  from  lo  to  50  gm.  (3-^  to  1%  oz.)  carbohydrate 
is  given  together  with  30  gm.  (i  oz.)  protein  and  30  gm. 
(i  oz.)  fat.  Keeping  the  carbohydrate  at  a  constant 
level  (10  to  50  gm.),  the  protein  and  fat  are  increased 
10  gm.  {}i  oz.)  each  daily,  until  sugar  appears  or  until 
the  protein  intake  has  reached  a  level  oi  i}^  gm.  (22  gr.) 
per  kilo,  of  body  weight,  and  the  fat  has  reached  from 
100  to  150  gm.  (33^^  to  5  oz.)  If  on  this  food  intake 
the  patient  is  still  sugar  free,  the  carbohydrate  is  in- 
creased 10  gm.  {}i  oz.)  daily  until  glycosuria  appears 
and  a  fast  day  is  then  given.  Following  this  the  previous 
carbohydrate  level  reached  is  cut  in  half  while  protein 
and  fat  are  left  the  same,  i.e.,  13^^  gm.  (22  gr.)  protein 
per  kilo,  body  weight,  and  100  to  150  gm.  (i}^i  to  5  oz.) 
fat.  This  food  intake  is  kept  constant  for  a  few  days 
and  the  patient  is  then  sent  home  and  told  to  keep  this 
diet. 

Should  glycosuria  appear  while  the  patient  is  on  a 
fixed  low  carbohydrate  intake  as  described  above  and 
while  the  protein  and  fat  are  being  increased,  a  fast 
day  is  given;  following  the  fast  the  protein  and  fat 
intake  are  lowered  from  10  to  20  gm.  {}i  to  %  oz.)  and 
kept  constant  while  the  carbohydrate  is  gradually  in- 
creased 5  gm.  (75  gr.)  daily  until  sugar  appears  again 
in  the  urine.  Another  fast  day  is  then  given  and  sub- 
sequent diet  is  directed  as  the  physician  in  attendance 
sees  fit. 


I02  DIABETIC   DIETS 

In  the  severe  cases  the  procedure  adopted  depends  on 
the  degree  of  acidosis,  and  on  whether  coma  is  threaten- 
ing or  not.  If  this  is  not  the  case,  the  patient's  diet  is 
gradually  reduced  in  carbohydrates  until,  after  a  few 
days,  they  are  fasted  and  put  on  diet  No.  i,  or  the  stand- 
ard strict  diet  No.  2.  This  usually  converts  a  severe 
into  a  medium  severe  case,  and  the  diet  is  then  planned 
as  already  outlined  in  the  medium  severe  cases. 

If  coma  is  impending,  the  patients  are  given  a  plain 
saline  infusion  into  the  vein,  and  urged  to  take  from  5 
to  10  gm.  (3^^  to  3^  oz.)  salt  by  mouth  in  the  expectation 
that  subcutaneous  edema  will  be  induced  and  the  ketone 
bodies  stored  in  the  tissues.  In  addition  glucose  is 
given  by  mouth,  particularly  if  the  patients  have  been 
previously  starved  of  carbohydrates.  When  the  danger 
of  coma  is  past,  they  are  treated  as  the  medium  severe 
cases. 

When  patients  reach  a  fair  maintenance  diet,  sufficient 
to  keep  their  weight  stationary  at  the  new  low  level, 
they  are  allowed  up  and  encouraged  to  exercise  vigor- 
ously, as  tending  to  increase  carbohydrate  tolerance. 

It  is  found  convenient  to  make  the  addition  in  the 
carbohydrate  allowance  by  using  definite  amounts  of 
5,  10,  15,  and  20  per  cent,  vegetables  as  shown  by  the 
list  of  vegetables. 

Diets  3,  4,  5,  6,  7  and  8  simply  represent  examples  of 
definite  amounts  of  protein,  fat  and  carbohydrates 
which  may  be  used  as  one  wishes  to  increase  or  vary  the 


DIABETIC  DIETS  IO3 

diet,  remembering  that  they  are  only  examples  and 
that  in  all  this  work  food  is  used  quantitatively  with 
specific  reference  to  the  amount  of  protein,  fat,  carbo- 
hydrates and  calories  furnished  the  system.  In  order 
to  compute  the  diabetic  diets  most  readily,  reference 
should  be  made  to  the  table  of  foods  on  pages  134  and 
147.  Using  those  compiled  by  Atwater  and  Bryant — 
Fisher's  100  calory  portions  or  the  table  arranged  by 
Geyelin  and  Foster — the  latter  being  the  one  particu- 
larly used  at  the  Presbyterian  Hospital,  page  154. 

Joslin's  Resume  of  Allen's  Treatment  for  Diabet 

Fasting. — Fast  until  sugar  free.  Drink  water  freely 
and  one  cup  of  tea  and  one  cup  of  coffee  if  desired.  If 
sugar  persists  after  two  days  of  fasting,  add  in  divided 
portions  300  c.c.  (10  oz.)  clear  meat  broth. 

Alcohol. — If  acidosis  (diacetic  acid)  is  present,  give 
0.5  c.c.  (7  m.)  of  alcohol  per  kilogram  (2.2  lbs.)  body 
weight  daily  until  acidosis  disappears.  Alcohol  is  best 
given  in  small  doses  every  three  hours. 

Carbohydrate  Tolerance. — When  the  twenty-four  hour 
urine  is  sugar  free,  add  150  gm.  (5  oz.)  of  5  per  cent, 
vegetables,  and  continue  to  add  5  gm.  {%  oz.)  carbohy- 
drate daily  up  to  20  gm.  {%  oz.)  and  then  5  gm.  (3-^  oz.) 
every  other  day,  passing  successively  upward  through 
the  5,  10  and  15  per  cent,  vegetables,  5  and  10  per  cent, 
fruits,  potato  and  oatmeal,  to  bread,  unless  sugar  appears 


I04  DIABETIC  DIETS 

or  the  tolerance  reaches  3  gm.  (45  gr.)  carbohydrate 
per  kilogram  (2.2  lbs.)  body  weight. 

Protein  Tolerance. — When  the  urine  has  been  sugar 
free  for  two  days  add  20  gm.  {%  oz.)  protein  (three 
eggs)  and  thereafter  15  gm.  (3^^  oz.)  protein  daily  in 
the  form  of  meat,  until  the  patient  is  receiving  i  gm. 
(15  gr.)  protein  per  kilogram  body  weight,  or  if  the 
carbohydate  tolerance  is  zero,  only^^gm.  (12  gr.)  per 
kilogram  body  weight.  Later,  if  desired,  the  protein 
may  be  raised  to  1.5  gm.  (22  gr.)  per  kilogram  body 
weight. 

Fat  Tolerance. — While  testing  the  protein  tolerance, 
a  small  quantity  of  fat  is  included  in  the  eggs  and  meat 
given.  Add  no  more  fat  until  the  protein  reaches  i 
gm.  (15  gr.)  per  kilogram  (2.2  lbs.)  body  weight  (unless 
the  protein  tolerance  is  below  this  figure),  but  then  add 
25  gm.  {%  oz.)  fat  daily  until  the  patient  ceases  to  lose 
weight  or  receives  not  over  40  calories  per  kilogram 
body  weight. 

Reappearance  of  Sugar. — The  return  of  sugar  demands 
fasting  for  twenty-four  hours  or  until  sugar  free.  The 
diet  preceding  the  reappearance  of  sugar  is  then  re- 
sumed except  that  the  carbohydrate  should  not  exceed 
half  the  former  tolerance  until  the  urine  has  been  sugar 
free  for  two  weeks,  and  it  should  not  then  be  increased 
more  than  5  gm.  (75  gr.)  per  week. 

Weekly  Fast  Days. — Whenever  the  tolerance  is  less 
than  20  gm.  {%  oz.)  carbohydrate,  fasting  should  be 


DIABETIC  DIETS  IO5 

practised  one  day  in  seven;  when  the  tolerance  is 
between  20  and  50  gm.  (%  to  1%  oz.)  carbohydrate,  5  per 
cent,  vegetables  and  one-half  the  usual  quantity  of 
protein  and  fat  are  allowed  upon  the  fast  day;  when 
the  tolerance  is  between  50  and  100  gm.  (1%  to  33^  oz.) 
carbohydrate,  the  10  per  cent,  and  15  per  cent,  vege- 
tables are  added  as  well.  If  the  tolerance  is  more  than 
100  gm.  {^}i  oz.)  carbohydrate,  upon  the  weekly  fast 
day  the  carbohydrate  should  be  halved. 

Bread  is  seldom  prescribed,  because  it  is  so  easy  for  a 
patient  to  overstep  the  Hmits.  Many  patients  use 
bread  substitutes,  such  as  Huntley  and  Palmer's  AkoU 
Biscuits,  Barker's  Gluten  Flour  (Brand  A),  Hepco 
Flour  (Lyster  Bros.),  Diabetic  Flour  (Whitefield,  New 
Hampshire) .  The  quantity  of  fat  which  it  is  necessary 
to  give  a  severe  case  is  considerable.  A  diabetic 
weighing  60  kilograms  (132  lbs.)  requires  at  least  30 
calories  per  kilogram  body  weight  to  be  up  and  about 
the  hospital,  with  an  occasional  walk.  Since  in  the 
severe  cases  not  more  than  10  gm.  (3^^  oz.)  carbohy- 
drate, representing  40  calories,  can  be  given  in  this  form, 
and  seldom  more  than  75  gm.  {2)4  oz.)  protein  (1.25  gm. 
(20  gr.)  per  kilogram  body  weight)  which  would  amount 
to  300  calories  more,  the  balance  of  the  diet  must  be 
made  up  of  150  gm.  (5  oz.)  fat,  amounting  to  1350 
calories,  and  even  more  unless  15  gm.  {^i  oz.)  alcohol 
are  given,  which  would  amount  to  105  calories. 


io6 


DIABETIC  DIETS 


Quantity  of  Food  Required  by  a  Severe  Diabetic  Patient 
Weighing  6o  Kilograms  (132  lbs.) 


Food 


Quantity, 
grams 


Calories 
per  gram 


Total. 
Calories 


Carbohydrate 

Protein 

Fat 

Alcohol 


10  (  J^oz.) 
7S(2Koz.) 
150  (soz.) 
15  (  Moz.) 


40 

300 

1350 

loS 

1 795 


Should  the  patient  remain  sugar-free  and  the  weight 
be  maintained  upon  this  diet,  gradually  the  quantity  of 
fat  could  be  lowered  and  the  carbohydrate  increased. 
A  very  few  of  the  patients  have  a  tolerance  for  between 
200  and  300  gm.  (6%  to  10  oz.)  of  carbohydrate.  With 
most  the  tolerance  is  below  100  gm.  (33^^  oz.)  and  with 
the  majority  it  is  under  50  gm.  {1%  oz.). 

The  patient  should  have  one  day  of  restricted  diet 
each  week,  no  matter  how  mild  the  case.  This  is  done 
partly  to  spare  the  function  which  controls  the  carbo- 
hydrate metabolism,  but  also  to  remind  the  patient  of 
what  a  strict  diet  really  is.  The  patient  is  told  to  gain 
little  or  no  weight,  and  as  Allen  advises,  not  to  come  up 
to  his  former  weight.  The  severer  cases  examine  the 
urine  daily,  and  the  milder  ones  once  a  week.  The 
patients  are  instructed  to  lead  less  strenuous  lives. 
Unfortunately,  they  feel  so  well  that  often  this  advice 
is  disregarded,  and  he  believes  that  all  of  us  err  in 


DIABETIC  DIETS  107 

allowing  our  patients  to  do  too  much.    They  should 
have  nine  hours  in  bed  at  night,  and  should  have  a 


quiet  hour  of  rest  each  day,  no  matter  how  well  they  , 


.  iitjui    vji.    i^OL   ^OiK^u,  Kxajr  )   uyj   ij.i.a\,\,\^t.    xxv/vv     rv^u.    kxi^jr 

feel. 


PURIN-FREE  DIETS 
Liquid  Purin-free  Diet 

(Folin) 

Whole  milk 500  c.c.   (  16  oz.). 

Cream  (18  to  22  per  cent.  fat).  300  c.c.  (  10  oz.). 

10  eggs  (whites  and  yolks) ....  450  gm.  (  15  oz.). 

Horlick's  malted  milk 200  gm.  (6%  oz.). 

Sugar 20  gm.  (  %  oz.). 

Sodium  chloride 6  gm.  (  3^  oz.). 

Water q.  s.  ad.  2000  c.c.   (  64  oz.). 

Extra  water 900  c.c.  (  30  oz.). 

Yields 

Protein 139  gm.  (4%  oz.) 

Fat 146  gm.  (4^  oz.)       2830  calories. 

Carbohydrate.225  gm.  (73^^  oz.) 

Soft  Purin-free  Diet^ 

6  A.M.:  Milk,  180  c.c.  (6  oz.). 
8  A.M. — Breakfast: 

Milk,  180  c.c.  (6  oz.). 
1 3^  slices  of  bread  and  i  pat  of  butter. 
2  tablespoonfuls  wheatina  or  cream  of  wheat  with 
cream,  60  c.c.  (2  oz.),  and  2  tablespoonfuls  of 
sugar. 
I  soft-boiled  egg. 

^  Vanderbilt  Clinic  diet  lists. 
108 


PURIN-FREE   DIETS  IO9 

12  M. — Dinner: 

Milk,  180  c.c.  (6  oz.). 

I  soft-boiled  egg,  s.  o.  s. 

Potato  with  cream,  30  c.c.  (i  oz.),  and  i  pat  of 

butter. 
Lettuce  or  cabbage  with  dressing. 
i}^  slices  of  bread  with  i  pat  of  butter. 

3  P.M.:  Milk,  180  c.c.  (6  oz.). 

5  P.M. — Supper: 

I  soft-boiled  egg,  s.  o.  s. 

Milk,  180  c.c.  (6  oz.). 

23^  tablespoonfuls  of  rice  with  cream,  30  c.c.  (i  oz.), 

and  I  tablespoonful  of  sugar. 
Crackers  with  butter,  i  pat. 
I  cube  of  cheese  (2  inches). 

1  cup  of  weak  tea  with  cream,  30  c.c.  (i  oz.),  and 
I  teaspoonful  of  sugar,  S.  O.  S. 

8  P.M.:  Milk,  180  c.c.  (6  oz.). 

Protein,  80  gm.  {2%  oz.);  fat,  112  gm.  (33^  oz.);  car- 
bohydrate, 207  gm.  (7  oz.) ;  calories,  2300. 

Diet  in  Gout^ 
Breakfast: 
Any  fresh,  cooked,  or  preserved  fruit. 
Cereal  with  sugar  and  milk  or  cream. 
White  bread,  toast,  muflins,  biscuits,  butter. 

2  eggs  (any  style). 

Milk,  with  slight  amount  of  coffee,  tea,  or  cocoa. 

^  Modified  from  Von  Noorden. 


no  PURIN-FREE  DIETS 

Lunch  and  Dinner : 

Soups. — Cream,   potato,   or  from   any  vegetable 

given  below,  prepared  without  meat  or  meat 

extract. 
Eggs,  any  style. 
Meat  and  Fish. — Once  a  day  one  of  the  following: 

Ham,  boiled  beef,  boiled  chicken,  boiled  mutton^ 

pot  roast,  any  boiled  fish. 
Vegetables. — Potatoes,  sweet  potatoes,  cauliflower, 

lettuce,  cabbage,  spinach,  okra,  egg-plant,  corn, 

Brussels  sprouts,  rice,  macaroni,  noodles. 
Bread. — Crackers,  white  bread,  toast,  butter. 
Desserts. — Fresh,  cooked,   or  preserved  fruit,  all 

desserts  (ice-cream,  pudding,  cake,  pie,  etc.)  not 

flavored  with    coffee  or  chocolate    American, 

Swiss,  and  cream  cheese. 
Beverages. — Milk,    cider,    water,    Vichy    or    any 

carbonated   water.     Grapejuice  and   raspberry 

syrup  allowed. 

Approximate  Values  to  be  Given 

Total 

Protein  Carbohydrate  Fat  calories 

Men.. .  .60  gm.  (2     oz.)    350  gm.  (11%  oz.)     60  gm.  (2     oz.)     2200 

Women.sogm.  (i%oz.)    3oogm.  (10     oz.)     sogm.  (i%oz.)     1800 

PuRiN-FREE  Articles  of  Diet^ 
Milk. 
Eggs. 

Bread,  white  only  (not  graham  or  whole  wheat). 
Butter. 

^  Vanderbilt  Clinic  diet  lists. 


PURIN-FRI5E  DIETS  III 

Biscuits. 

Cereals  (hominy,  rice,  farina). 

Cream. 

Sugar  and  syrup. 

Jam  and  marmalade. 

Cake. 

Cream  soups. 

Vegetables: 

Potatoes  (slight  amount  of  purin). 

Cauliflower. 

Cabbage. 

Lettuce. 

Egg-plant. 
Desserts: 

Nuts. 

Cheese. 

Ice-cream  and  water-ices. 

Cake    (any   cake   except   with   cofifee   or   chocolate 
flavor). 

Rice,  bread,  farina,  tapioca,  or  cornstarch  pudding. 

Custard  or  cocoanut  pie. 

The  Purin  Bodies  in  Various  Food -stuffs  ^ 

T-,.  ,  ^  Purin  bodies, 

grams  per  kilo 

Cod 0.5 

Plaice 0.7 

Salmon i .  i 

Halibut I .  o 

1  Hall  J.  Walker,  The  Purin  Bodies  of  Food  Stuffs  and  the  R6le  of 
Uric  Acid  in  Health  and  Disease,  2d  ed.  rev.,  London,  1903. 


112  PURIN-FREE   DIETS 

Meat:  ^"°  ^°^^^' 

grams  per  kilo 

Beef 1.3-2.0 

Fat I.I 

Mutton o .  96 

Fat 

Veal I.I 

Fat 

Pork 1.2 

Fat 0.5 

Ham I.I 

Chicken 1.2 

Meat  soups  (varying  large  amounts). 

Vegetables: 

Potatoes o .  02 

Rice 

Flour  (white) 

Bread  (white) 

Oatmeal o  •  53 

Peas o  •  39 

Lentils 0.38 

Beans  (Haricot) o. 63 

Asparagus 0.21 

Cabbage 

Lettuce 

Cauliflower 

Onions o .  09 

Tapioca 


PURIN-FREE  DIETS  II3 

«        •  1  t:«      J  Purin  bodies, 

Special  Foods:  „  , ., 

^  grams  per  kilo 

Milk 

Butter 

Eggs 

Cheese  (fat) 

Drinks: 

Beer,  lager 0.12 

Ale 0.14 

Porter '. 0.15 

Per  pint 
(soo  c.c.) 

Tea 1.2 

Cocoa I .  o 

Chocolate 0.7 

CofFee 1.7 

Claret 

Sherry 

Port 

Comments  on  Purin-Free  Diets 

Since  in  gout  the  purin  metaboUsm  is  faulty,  the  aim 
of  its  dietetic  treatment  should  be  to  furnish  a  food 
containing  Uttle  or  no  purin  bodies. 

In  the  liquid  purin-free  diet,  as  designed  by  Folin, 
we  have  a  diet  that  is  useful  almost  exclusively  for  scien- 
tific purposes,  when  one  wishes  to  determine  the  amount 
of  endogenous  uric  acid  that  is  excreted.    It  can,  how- 


114  PURIN-FREE   DIETS 

ever,  be  used  to  advantage  during  an  acute  attack  of 
gout,  although  it  contains  about  twice  too  much  protein,  . 
and  in  the  acute  stage  a  milk  diet  is  better. 

The  soft  purin-free  diet  can,  for  the  most  part,  be 
used  in  acute  gout,  and  is  much  more  palatable.  The 
amount  of  protein  or  the  total  calories  can  be  reduced 
or  increased  at  will  to  meet  the  requirements  of  large 
or  small  individuals.  The  list  given  is  sufl&cient  for  a 
man  of  70  kilos  (154  pounds).  Women  seldom  have 
acute  gout. 

The  list  of  purin-free  articles  of  diet  is  inserted  to 
help  one  prescribe  a  variety  in  case  the  diet  is  continued 
for  some  time. 

The  diet  given  specifically  for  chronic  gout  can  be 
modified  from  the  purin-free  list  as  well,  and,  while 
this  diet  for  gout  is  not  absolutely  purin  free,  it  is  of  a 
low  purin  content,  and  boiling  the  meats,  particularly 
if  they  are  boiled  in  two  waters,  removes  a  great  part  of 
the  purins. 


OBESITY  DIETS 

(Richter) 

Early  A.  M. :  Cupful  of  tea,  no  milk  or  sugar. 
Ham,  40  gm.  {i}i  oz.)- 
I  roll  (dry). 
10  A.  M.:       Fresh  fruit. 
12  A.  M.:       Fresh  fruit. 

2  P.  m:        Clear  soup,  100  gm.  (33^  oz.);  lean  meat, 
plenty    of    green    vegetables    without 
butter  or  milk. 
Salad. 

I  or  2  glasses  of  lemonade  without  sugar. 
Use  saccharin  if  wanted. 
4  p.  M. :      Cup  of  tea. 
6  p.m.:       Fruit. 

8  p.m.:        75  gm.  {2}^^  oz.)  of  lean  meat,  radishes, 
potato  (small  one),  sour  pickles. 
Take  one  or  two  steam  baths  per  week. 

Protein,  75  gm.  (2^^  oz.) ;  fat,  50  gm.  (i^  oz.) ;  carbo- 
hydrate, 130  gm.  (43^^  oz.) ;  calories,  1300. 


Il6  .  OBESITY  DIETS 

(Tebbles) 

Breakfast:    Milk,  500  c.c.  (i  pint). 

Luncheon:     Meat,  180  gm.  (6  oz.).    A  plate  of  boiled 

vegetables  (bread  and  potatoes  are  not 

allowed).    Junket,  250  gm.  Q^i  pint). 

5  p.  M. :  Junket,  250  gm.  (>^  pint),  two  cups  of  tea, 

with  very  little  sugar. 
Dinner:         Milk,  500  c.c.  (i  pint),  2  apples. 
Approximate  Values 
Protein  100  gm.  {^}i  oz.) ;  fat,  60  gm.  (2  oz.) ;  carbo- 
hydrate, 50  gm.  (1%  oz.);  calories,  1800. 

Comment  on  Obesity  Diets 

The  accumulation  of  fat  in  the  subcutaneous  tissues 
is  due  either  to  an  excess  of  food  combined  with  too 
little  work,  or  it  is  a  true  disease,  in  which  case  fat  is 
deposited  in  spite  of  a  small  ration.  In  the  first  in- 
stance, diet  alone  combined  with  exercise  is  necessary 
for  reduction;  in  the  second  variety  other  methods  must 
be  used  as  well. 

Reduced  to  its  simplest  terms  the  dietary  treatment 
of  obesity  in  the  simple  variety  may  be  summed  up  as 
"less  food — more  work."  Actually,  it  is  not  as  simple 
as  this  for  the  protein  allowance  must  be  kept  up  to 
normal  and  the  reduction  made  in  carbohydrate  and 
fats,  the  latter  being  the  intensive  fat-building  bodies. 
Combined  with  this  there  must  go  a  definite  method  of 
muscular  exercise. 


OBESITY  DIETS  II7 

Von  Noorden's  regimen  for  reduction  in  obesity  is 
perhaps  the  most  rational  one  and  depends  for  its 
success  upon  reduction  of  the  caloric  intake  of  the  indi- 
vidual as  calculated  for  the  amount  one  should  weigh  for 
a  certain  height  (see  page  133)  and  then  reducing  the 
intake  to  a  point  below  this,  the  exact  amount  to  be 
determined  by  the  degree  of  obesity.  Thus,  there  is  a 
reduction  for  a  slight,  moderate  or  marked  obesity. 

For  a  normal  person  weighing  70  kilos  (154  pounds) 
38  calories  per  kilo  are  required  as  a  "maintenance" 
diet,  i.e.,  2590  calories.  If  an  individual  weighs  100  Kg. 
(220  pounds)  i.e.,  30  Kg.  (66  lbs.)  more  than  he  should 
for  his  height,  it  requires  mo  extra  calories  to  maintain 
these  30  Kg.  overweight.  Since  we  know  that  2590 
calories  constitutes  a  maintenance  diet  for  the  normal 
weight  for  that  particular  height,  we  must  plan  a  diet 
which  is  one-fifth,  two-fifths,  or  three-fifths  less  than  the 
maintenance  diet  according  as  the  reduction  is  to  be 
undertaken  for  a  mild,  medium  or  severe  degree  of 
obesity,  i.e.,  the  first  degree  of  reduction  would  call  for 
a  diet  of  2000  calories,  the  second  degree  of  reduction 
1500  calories  and  the  third  degree  of  reduction  1000 
calories.  For  the  first  degree  of  reduction  it  is  often 
only  necessary  to  omit  all  visible  fat,  such  as  oils,  butter, 
fat  meat,  have  vegetables  cooked  without  fat,  sweets 
should  be  eliminated  and  alcohol  prohibited.  For  the 
second  and  third  degree  of  reduction  it  may  be  neces- 
sary to  accurately  calculate  and  weigh  the  foods  imtil 


Il8  OBESITY  DIETS 

the  eye  becomes  trained  to  the  correct  amounts.  The 
severe  degree  of  reduction  should  never  be  undertaken 
except  under  strict  supervision  in  hospital  or  sanita- 
rium. With  the  reduction  in  food  calories,  graduated 
exercises  should  be  arranged  to  maintain  muscular 
strength  and  even  to  increase  it,  as  otherwise  the 
patient  will  be  left  after  reduction  with  a  depleted 
neuro-muscular  system  and  his  last  state  be  worse  than 
his  first.  In  all  these  diets  the  protein  should  be  kept 
at  a  moderately  high  level  to  prevent  undue  loss  of 
body  protein  as  the  fats  and  carbohydrates,  the  normal 
protein  sparers,  are  markedly  limited.  Approximately 
80  to  100  gm.  protein  should  be  allowed  and  in  some 
cases  more. 

The  examples  of  diet  in  obesity  are  only  given  to 
show  in  a  general  way  what  foods  are  principally  useful 
in  this  process  of  reduction  and  they  are  also  examples 
of  diJBferent  degrees  of  restriction  in  caloric  value.  It 
is  much  better  to  plan  a  definite  diet  for  each  case  as 
can  be  readily  done  by  means  of  Fisher's  100  caloric 
portions  (see  page  147). 

It  is  a  good  plan  to  make  the  lightest  meal  at  night 
is  the  body  can  more  than  use  up  during  sleep,  a  supper 
of  low  caloric  value. 


OBESITY  DIETS 
FIVE  THOUSAND  CALORIE  DIET 


119 


Food 

Gm. 
amt. 

Oz. 

Pro. 

Fat 

CH. 

Meals 

Grapes 

ISO 

5 

IS 

1.8 

21.6 

Breakfast: 

Grapenuts. . . 

6S 

3 

7.7 

0.4 

Si.S 

Grapes 

Bacon 

36 

I 

3.2 

20.8 

Grapenuts — cream 

Egg 

SO 
120 

4 

6.7 
II. 6 

S-2 
0.2 

Omelet — bacon 

Bread 

64.2 

Toast — butter 

Butter 

6S 

2 

S3. 2 

Coffee — sugar 

Cream 

160 

SH 

3-4 

S7.8 

4.2 

Sugar 

Rs 

2% 

85.0 

Dinner: 

Gr  ap  ef  ruit — sugar 

Grapefruit. . . 

300 

10 

2.3 

0.6 

30.2 

Cream  of  pea  soup 

Pea  soup .... 

I2S 

4 

6.2 

8.4 

14.0 

Roast  chicken 

Chicken 

100 

3H 

32.1 

4-4 

Sweet  potatoes 

Lima  beans. . 

80 

2% 

6.4 

o.S 

23.6 

Lima  beans 

Corn  on  cob. 

100 

3H 

30 

I.I 

18.8 

Corn  on  cob 

Sweet  potato. 

60 

2 

1-5 

9.S 

31.0 

Tomato  salad 

Lettuce 

24 

I 

0.2 

0.4 

0.6 

Charlotte  russe 

Tomato 

ISO 

S 

1-3 

0.6 

S.8 

Coffee 

Oil 

3S0 

Charlotte 

Supper: 

russe 

2S 

I 

2.0 

6.4 

32.2 

Broiled  sweetbread 
— cream  sauce 

Sweetbreads.. 

100 

3H 

16.8 

12. 1 

Biscuit — butter 

Biscuit 

46 

l\i 

3.8 

S.2 

19.9 

Date    and    cheese 

Dates 

28 

I 

2.8 

0.2 

48.2 

salad 

Cheese 

40 

iH 

2.5 

3-2 

0.2 

Peaches — cream 

Peaches 

100 

3H 

0.7 

O.I 

9.4 

Chocolate  cake 

Calories 

Cake 

70 

2H 

4.3 

S.6 

44.8 

• 

P  . . .     521. II 

Chocolate. . . . 

180 

6 

6.8 

13.3 

26.0 

F 2287.80 

CH.  .22X1 .54 

127. 1 

246.0 

5394 

Total  S020.45 

This    diet    ws 

is    pi 

anned    for    fall    season. 

The  object  considered  is  to  get 

The   following 

foo 

Is   may   be  substituted 

nourishing     concentrated    foods. 

for  other  ses 

isons 

with  as  little  bvilk  as  possible. 

Fruits: 

Strawberries 

100 

zH 

I.O 

0.6 

7.4 

Prunes 

100 

zH 

0.9 

18.9 

Pineapple. . . 

100 

3H 

0.4 

0.3 

9.7 

Baked  apple 

120 

4 

0.6 

o.S 

29.3 

Green  peas. 

92 

3 

6.1 

31 

13.4 

Canned  corn 

100 

zH 

2.8 

1.2 

19.0 

Creamed 

celery 

90 

3 

1.4 

4-9 

3.4 

I20  LOW-CALCIUM  DIETS 

Comment  on  The  Five  Thousand  Calorie  Diet 

In  certain  conditions  it  is  necessary  to  increase  the 
food  intake  much  above  the  average  allowance.  This 
is  especially  true  in  many  cases  of  exophthalmic  goiter 
with  malnutrition.  When  there  is  a  tendency  to  diar- 
rhea or  intestinal  indigestion  it  is  usually  best  to 
reduce  the  fruit  and  vegetable  allowance,  and  to  sub- 
stitute cereals  or  extra  bread  and  butter.  This  diet,  of 
course,  may  be  modified  in  detail  so  that  the  daily 
routine  shall  not  become  monotonous,  keeping  however 
approximately  to  the  same  amounts  of  corresponding 
caloric  value. 


LOW -CALCIUM  DIET 

Boiled  meat 250  gm.  (  S}4  oz.) 

Bread * 100  gm.  (  33^  oz.) 

Fish 100  gm.  (  $}i  oz.) 

Potatoes 100  gm.  (  3H  oz.) 

Apple 100  gm.  (  3K  oz.) 

Sugar 50  gm.  (  i^^  oz.) 

Butter 50  gm.  (  1%  oz.) 

Tea  (with  cream) 100  gm.  (  sH  oz.) 

Calcium  content,  0.315  gm.  (4.6  grains). 

Protein,  80  gm.  {1%  oz.) ;  fat,  100  gm.  (sH  oz.) ;  car- 
bohydrate, 14s  gm.  (s  oz.) ;  calories,  2000. 


FIXED  NITROGEN,  CALCroM,  MAGNESroM  DIET      121 
FIXED  NITROGEN,  CALCIUM,  MAGNESIUM  DIET 
(Vogel) 
(Twenty-four-hour  Amount) 

Milk 500  gm.  (16%  oz.) 

Eggs 300  gm.  (  10  oz.) 

Cream 300  gm,  (  10  oz.) 

Rice,  uncooked 100  gm.  (  33'^  oz.) 

N  in  twenty-four-hour  amounts,  8.138  gm.  CaO  in 
twenty-four-hour  amounts,  1.2 14  gm.  MgO  in  twenty- 
four-hour  amounts,  0.175  gm.     Calories,  1900. 

Comments  on  Low -calcium  Diet 

This  was  designed  by  Dr.  C.  G.  L.  Wolf,  of  the  Cornell 
Medical  School,  at  the  suggestion  of  my  colleague, 
Dr.  David  Bovaird,  Jr.,  who  conceived  the  idea  that 
cases  of  chronic  deforming  arthritis  might  be  greatly 
benefited  by  reducing  the  calcium  intake,  on  the  theory 
that  the  disease  is  due  to  a  disturbed  calcium  meta- 
bolism. This  has  been  used  in  a  number  of  cases,  both 
at  the  Presbyterian  and  Lincoln  Hospitals,  New  York, 
and,  while  it  has  not  resulted  in  any  cures,  some  of  the 
patients  have  been  greatly  reheved  of  their  pain  while 
on  the  diet.  Its  monotony  is  its  worst  feature,  and  one 
can  seldom  get  patients  to  continue  its  use  for  long  at  a 
time.  Theoretically,  tetany  might  seem  a  possible  con- 
sequence of  withdrawing  the  calcium  from  the  diet,  but 
in  one  case  in  which  Bovaird  used  this  diet  for  many 
months  there  was  no  evidence  of  this. 


122      FIXED  NITROGEN,  CALCIUM,  MAGNESIUM  DIET 

The  diet,  moreover,  is  of  scientific  value  to  anyone 
desiring  to  study  calcium  metabolism. 

The  fixed  nitrogen,  calcium,  magnesium  diet  has 
been  used  exclusively  for  research  work,  and  is  an  ac- 
curate analysis  of  the  food  stuffs  composing  the  diet 
in  these  three  particulars. 

Regular  Convalescent  Children's  Diet  (Two  to  Five 
Years)  ^ 

Breakfast. 

8  A.  M.:        Cereal,  50  gm.  (1%  oz.). 

Toast    22    gm.    (i    oz.).    Butter,    4   gm. 

a^oz.). 

Egg,  (i). 

Milk,  250  c.c.  (8  oz.). 

10  A.  M.:      Orange  juice,  60  c.c.  (2  oz.). 

Dinner. 

12  noon:     Broth,  200  c.c.  (7  oz.). 
Meat,  15  gm.  (3^  oz.). 
Baked  Potato.     Rice,  50  gm.  {1%  oz.). 
Green  vegetable    (spinach,   carrots,   peas, 

string  beans,  or  parsnips)  strained  50  gm. 

{1%  oz.). 
Pudding  and  ice-cream,  50  gm.  {1%  oz.). 

2  p.  M.:        Cocoa,  200  c.c.  (7  oz.). 

1 H.  H.  Mason. 


FIXED  NITROGEN,  CALCIUM,  MAGNESIUM  DIET      1 23 

Supper. 

5  p.  M. :        Cereal,  50  gm.  {1%  oz.).     Bran  muffin,  22 
gm.  (i  oz.).     Butter,  4  gm.  (^^  oz.). 

Milk,  250  c.c.  (8  oz.). 

Stewed  fruit,  50  gm.  {1%  oz.). 
8  P.  M.:        Milk  or  broth,  200  c.c.  (7  oz.). 

Approximate  Values  to  he  Given 

Protein 52  gm.  (1%  oz.)      213 . 5  calories 

Fat 52  gm.  {1%  oz.)      483 .6  calories 

Carbohydrate  . . .   186  gm.  (6  oz.)  762 .6  calories 


1459 -7 


Special  Diet  for  Children  .  (Two  to  Five  Years)  Con- 
valescing FROM  Diarrheal  Diseases^ 

Breakfast. 

8  A.  M.:       White  cereal,  60  gm.  (2  oz.). 

Toast,  22gm.  (loz.).     Milk,  2 50 c.c.  (8 oz.). 

Dinner. 

12  noon:    Coddled  egg  (i). 

Rice  or  rice  pudding,  50  gm.  (2  oz.). 
Dry  bread,  22  gm.  (i  oz.) .     Broth,  200  c.c. 
(70Z.). 
2  p.  M.:      Beef  juice,  30-60  c.c.  (1-2  oz.). 
i  H.  H.  Mason. 


124      FIXED  NITROGEN,  CALCIUM,  MAGNESIUM  DIET 

Supper. 

5  p.  M. :        White  cereal,  50  gm.  (i  oz.) .     Zwiebach,  10 
gm.  {yi  oz.). 

Custard  or  junket,  50  gm.  (2  oz.). 

Milk,  250  c.c.  (8  oz.). 
8  P.  M.:       Milk  or  broth,  200  c.c.  (7  oz.). 

Approximate  Values  to  be  Given 

Protein 43  gm.  (ij-^  oz.).     176.3  calories 

Fat 41  gm.  {i^i  oz.).     381 .3  calories 

Carbohydrate. .  1 13  gm.  (3%  oz.) .      463 . 3  calories 

1020.9  calories 


SPECIAL  DIABETIC  RECIPES' 
Diabetic  Bread  and  Biscuit 

Akoll  Biscuit  (Huntley  and  Palmer). 

Carbohydrate,  2.7  per  cent.;  nitrogen,  7  per  cent. 
Each  biscuit  weighs  5.1  gm.  and  contains  0.14  gm. 
carbohydrate  and  0.41  gm.  nitrogen. 
Gluten    meal    biscuit,    made    from    Barker's    Gluten 
Food  A,  to  be  had  of  Herman  B.  Barker,  Somer- 
ville,  Mass. 
Carbohydrate  not  over  4  per  cent.;  nitrogen,   13 
per  cent. 
Soja-bean  meal  biscuit  from  Soja-bean  meal,  to  be 
had  of  Thomas  Metcalf  Company,  Boston,  Mass. 
Protein  (N.  X  6.25),  44.64  per  cent.;  fat,  19.43  per 
cent.;  cane-sugar,  9.34  per  cent.;  starch,  none. 
Casoid  biscuit,  to  be  had  of  Thomas  Leeming  &  Co., 
New  York  City. 
Carbohydrate,  8  per  cent.;  nitrogen,  10  per  cent. 
Pure  gluten  biscuit  and  potato  gluten  biscuit,  to  be 
had  of  Battle  Creek  Sanitarium  Food  Company. 
Carbohydrate,  10  per  cent.;  nitrogen,  12  per  cent. 
Protopuff  No.  I,  Health  Food  Company,  New  York. 
Carbohydrate,  10  per  cent.;  nitrogen,  12  per  cent. 

Diabetic  Milk  (Wright's) 

Definite  quantity  of  milk  diluted  with  three  to  four 

volumes  distilled  water,  to  which  i  or  2  :  1000  glacial 

1  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 

125 


126  SPECIAL  DIABETIC   RECIPES 

acetic  acid  has  been  added  (6-12  c.c,  dr.  1^-3,  glacial 
acetic  acid;  i  pint  or  500  c.c.water).  This  precipitates 
all  casein  and  fat. 

Allow  to  settle,  then  strain  through  calico.  Wash 
repeatedly.  Redissolve  curd  in  a  i  per  cent,  solution 
of  the  following  mixture,  enough  to  make  the  original 
amount  of  milk: 


Sodium  chlorid 11 

Potassium  chlorid 9 

Monopotassium  phosphate 13 

Dipotassium  phosphate 10 

Citrate  of  potassium 5 

Dimagnesium  phosphate 4 

Magnesium  citrate 4 

Dicalcium  phosphate 8 

Tricalcium  phosphate 9 

Calcium  citrate 25 

Calcium  oxid 5 

Sodium  carbonate 40 


Analysis  of  Wright's  Diabetic  Milk^ 

Specific  gravity,  loii. 

Ash o .  200  per  cent. 

Fat 3 .  600  per  cent. 

Protein i .  907  per  cent. 

Carbohydrate 0.015  per  cent. 


Total  solids 5-722  per  cent. 

NaCl o.  no  per  cent. 


^  Granatf 


MISCELLANEOUS  RECIPES 

Raised  Bran  Biscuits  : 
2  cups  of  bran. 
I  cup  of  entire  wheat  flour. 
Butter,  salt,  and  baking  powder. 
}4.  cup  of  molasses,  more  or  less  to  taste. 
1 3^  cups  of  milk. 

Bake  for  one  hour  in  gems,  in  slow  oven. 
(Eat  one  to  three  a  day,  when  stale.) 

Bran  Crackers  (Foord)  : 
Butter,  2  cups. 
Buttermilk,  Y^  cup. 
Molasses  (or  honey),  ^  cup. 
White  flour,  i  pint. 
Baking  soda,  2  teaspoonfuls. 
Bran,  \Y4^  quarts. 

Bake  in  flat  crackers,  3'^  inch  thick  and  2  inches 
wide. 

Cream  of  Pea  Soup: 

Canned  peas,  3^  cup. 
Salt. 

Water,  i^-^  oz.  (45  c.c). 
Milk,  6  oz.  (180  c.c). 
Butter,  I  dram  (4  gm.). 
Flour,  I  dram  (4  gm.). 
Lactose,  i  dram  (4  gm.). 
127 


128  MISCELLANEOUS   RECIPES 

Boil  first  three  ingredients,  strain,  and  add  milk, 
melted  butter,  flour,  and  lactose;  season.     Bring 
.  to  the  boiling-point  and  strain. 
30  c.c.  (i  oz.)  equals  protein  2.6  gm.     Calories,  32. 

Black  Bean  Soup: 

Black  beans,  2  tablespoonfuls. 

Cold  water,  i  cup. 

Seasoning — onion,  celery  salt,  salt,  and  pepper. 

Boil  beans  with  water,  strain,  and  add —    • 

Milk,  %  cup. 

Butter,  2  drams  (8  gm.). 

Flour,  I  dram  (4  gm.). 

Salt  and  pepper,  q.  s. 

30  c.c.  (i  oz.)  equals  protein  1.98.     Calories,  40. 

Lactose  Jelly: 

Gelatin,  3^^  teaspoonful 
Cold  water,  2  teaspoonfuls 
Orange  juice,  i3^  oz. 
Lemon  juice,  i  teaspoonful 
Cane-sugar,  13^^  teaspoonfuls. 
Sherry,  i  teaspoonful. 
Lactose,  3  tablespoonfuls  {I'^i  oz.). 
Boiling  water,  i3^  oz. 

Lactose  is  boiled  in  water  until  clear.  Pour 
over  soaked  gelatin  to  dissolve  and  add  other  parts. 
Strain  through  double  gauze  and  chill. 

May  also  be  flavored  with  grape  or  raspberry  juice. 


I  portion. 


miscellaneous  recipes  1 29 

Artificial  Buttermilk  : 

I  quart  fresh  milk  (fat-free  preferable).  Sterilize 
at  temperature  of  212°  F.  for  twenty  minutes. 
Cool  to  98°  F.  and  put  in  sterile  bottle.  Add  i  tube 
(i  c.c.)  of  lactobacillin  (The  Ferment  Co.).  Allow 
to  stand  at  temperature  of  95°  F.  for  twenty-four 
hours.  Beat  thoroughly  with  Dover  egg-beater 
and  chill. 

For  large  quantity,  use  3^  bottle  of  lactobacillin 
to  one  can  of  milk. 

Protein  Milk  (Eiweissmilch) 

Heat  I  quart  of  whole  milk  to  100°  F.  Add  4  tea- 
spoonfuls  of  essence  of  pepsin  and  stir.  Let  the  mixture 
stand  at  100°  F.  until  the  curd  has  formed.  Put  the 
mass  in  a  linen  cloth  and  strain  off  the  whey  from  the 
curd.  Remove  the  curd  from  the  linen  cloth  and  press 
it  through  a  rather  fine  sieve  two  or  three  times  by 
means  of  a  wooden  mallet  or  spoon.  Add  i  pint  of 
water  (500  c.c.)  to  the  curd  during  this  process.  The 
mixture  should  now  look  like  milk,  and  the  precipitate 
must  be  very  finely  divided.  Add  i  pint  of  butter- 
milk to  this  mixture. 

The  composition  of  this  food  is: 

Fats 2.5  per  cent. 

Sugar 1.5  per  cent. 

Protein 3.0  per  cent. 

Salt 0.5  per  cent. 

I  quart  of  this  milk  contains  about  370  calories. 


9 


130  miscellaneous  recipes 

Keller's  Malt  Soup 

2  oz.  (60  gm.)  of  wheat  flour  are  mixed  with  11  oz. 
(330  c.c.)  of  whole  milk  and  then  passed  through  a 
sieve.  In  a  second  vessel  3  oz.  (90  c.c.)  of  extract  of 
malt  are  mixed  with  20  oz.  (600  c.c.)  of  warm  water. 
The  two  mixtures  are  then  poured  into  a  porcelain 
vessel,  23^^  dr.  (10  gm.)  of  11  per  cent,  carbonate  of 
potassium  added,  and  the  whole  cooked  with  constant 
stirring  for  twenty  minutes,  and  then  brought  to  a 
momentary  boil;  any  loss  through  heat  is  made  up  by 
the  addition  of  boiled  water. 

The  composition  of  this  food  is: 

Fat 1 .  20  per  cent. 

Protein 2 .  00  per  cent. 

Cabohydrate 12 .00  per  cent. 

Caloric  value,  800  to  the  liter  (quart). 

Lactose  Ice-cream 

Cream 120  c.c.  (4  oz.) 

Lactose 30  gm.  (i  oz.) 

Boiling  water 30  c.c.  (i  oz.) 

Cane-sugar 4  gm.  (i  dr.) 

Salt I  gm.  (  }'-i  dr.) 

Vanilla i  gm.  (3-:^  dr.) 

Or, 

Sherry 15  c.c.  {}^i  oz.) 

Boil  lactose  and  water  two  minutes  or  until  clear. 
Mix  with  other  ingredients.  Freeze.  Equals  390 
calories. 


miscellaneous  recipes  131 

Martin's  Milk 

Milk,  I  pint  (500  c.c.)- 

Rennin,  3^^  gm.,  "j^i  grains,  or  liquid  rennet,  i  dram 
(4  c.c).  Heat  milk  to  98°  F.  Add  rennin  dissolved  in 
cold  water.  Allow  to  coagulate.  Beat  thoroughly  with 
dover  beater.     Season  with  salt  and  chill. 

Delafield's  Milk  Mixture 

Feeding  in  nausea : 

Cream 120  c.c.  (4  oz.) 

Milk 120  c.c.  (4  oz.) 

Vichy • 120  c.c.  (4  oz.) 

Soda  bicarbonate i3^  gm.  (20  gr.) 

Cerium  oxalate %  gm.  (10  gr.) 

Comments  on  Miscellaneous  Recipes 

The  list  of  food  stufifs  taken  from  Bulletin  28  of  the 
Department  of  Agriculture  is  indispensable  in  reck- 
oning the  protein,  fat,  and  carbohydrate  values  of  foods 
as  well  as  their  caloric  value. 

The  special  recipes  are  appended  and  will  be  found 
useful.  Those  for  diabetics  speak  for  themselves,  while 
the  lactose  jelly  and  ice-cream  will  be  found  a  convenient 
method  for  palatably  exhibiting  a  good  number  of 
calories. 


132  MISCELLANEOUS   RECIPES 

Delafield's  mixture  is  often  serviceable  in  the  feeding 
£>i  gastric  cases  accompanied  by  much  nausea  and  vomit- 
ing, beginning  with  dram  doses  every  twenty  minutes 
and  gradually  increasing  the  dose,  and  later  lengthening 
the  intervals. 

In  Eiweissmilch  (protein  milk)  we  have  a  preparation 
of  German  origin  which  is  useful,  at  times,  in  conditions 
of  intestinal  disturbance  associated  with  diarrhea.  It 
has  been  used,  as  has  Keller's  malt  soup,  particularly 
in  the  feeding  of  children,  but  either  may  be  of  great 
use  in  the  care  of  adults  where  milk,  either  alone  or 
with  the  usual  admixtures,  is  not  well  borne. 

Fisher's  table  of  "standard  portions"  of  loo  calories 
each,  forms  the  basis  for  the  easy  computation  and  con- 
struction of  any  of  the  diets.  The  addition  of  the  actual 
amount  of  protein,  fat,  and  carbohydrate  in  the  in- 
dividual portions  simplifies  the  determination  of  the 
amounts  of  these  food  elements  in  any  one  of  the  foods 
listed. 

Thus,  if,  for  example,  we  wish  to  figure  the  actual 
amount  of  food  for  a  day's  ration  in  an  anticonstipation 
diet,  we  take  the  fraction  or  multiples  of  loo  calories  of 
the  foods  called  for.  Slight  rearrangements  are  often 
necessary  to  keep  to  the  approximate  values  set  for  the 
different  diets;  the  following  is  an  example  of  the  method 
for  using  this  table — e.g.,  for  anticonstipation  breakfast. 


MISCELLANEOUS   RECIPES 


133 


Protein 

Calories  gm. 

Apple  (i)  (early  A.  m.)        50  0.3 

Oatmeal loo  4 . 4 

Molasses 200  i .  6 

Biscuit  (johnny  cake) .     200  6 .  o 

Egg 100  7.9 

Apple  (i) 50  0.3 

Prunes 200  1.4 

Butter 100 


Fat     Carbohydrate 


gm. 

03 
8 


1000       21.9       2  2.6 


gm. 
II  .0 

8.2 
48.0 

35-0 

II  .0 
46.8 


160.0 


AVERAGE  WEIGHTS  FOR  MEN  AND  WOMEN 

As  Compiled  by  the  Metropolitan  Life  Insurance 
Company 


Men 


Women 


Height, 
ft.    in. 


Weight, 
lbs. 


Height, 
ft.    in. 


5     I 120 

5      2 125 

5     3 130 

5     4 135 

5     5 141 

5     6 145 

5     7 150 

5     8 154 

5     9 159 

5  10 164 

5  II 169 

6  o 175 

6     1 181 

6     2 188 


10. 
II. 
o. 
I . 

2. , 

3- 

4. 

5- 
6. 

7- 
8. 

9- 


Weight, 
lbs. 

.  .108 

.  .  112 

.  .114 

..118 


5  10 
5  II. 


123 
126 
129 
133 
137 
142 

146 

150 
154 
158 


AVERAGE   CHEMICAL  COMPOSITION  OF  AMERICAN 
FOODS 

From  Atwater  and  Bryant  (Abstract),  United  States  Depart- 
ment OF  Agricxh-ttjrje 
(Bulletin  No.  28, 1906) 

Water.      Protein.         Fat. 
Per  cent.    Per  cent.    Per  cent. 


Food  Material. 
A.    Beef. 


^cfr»-  Calori^ 
per  100 
Per  cent.        gm.i 


Fresh: 

Chuck,  including  shoulder ...65.0  19.2  15.4 

Loin 61.3  19.0  19. 1 

Sirloin  butt,  as  purchased.  ..62.5  19.7  17.7 

Porterhouse  steak 60.0  21 .9  20.4 

Ribs 57.0  17.8  24.6 

Round 67.8  20.9  18.6 

Beef  Organs: 

Brain 80.6  8.8  9.3 

Kidney 76.7  16.6  4.8 

Beef  liver 71.2  20.4  4.5 

Sweetbreads,  as  purchased..  .70.9  16.8  12. i 

Tongue 70.8  18.9  9.2 

Cooked: 

Roast,  as  purchased 48.2  22.3  28.6 

Round  steak,  fat  removed,  as 

piu-chased 63.0  27.6  7.7 

Loin  steak: 

Tenderloin,  broiled 54.8  23.5  20.4 


Canned: 

Boiled  beef,  as  purchased.. . .  51 .8  25.5 

Corned  beef 51 .8  26.3 

Roast  beef ,  as  purchased 58.9  25.9 

^  Locke,  Food  Values. 
134 


22.5 
18.7 
14-8 


0.4 
1-7 


332 

2SS 
246 
280 
302 
184 


132 
"S 

181, 
163 


3S7 
287 


314 
282 

243 


CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS    135 


Food  Material.  Water. 

B.     Veal.  Percent. 

Fresh: 

Breast 68.2 

Leg 71-7 

Loin 69.5 

Rib 69.8 

Shoulder  and  flank,  medium 

fat 65.2 

Kidney,  as  pxirchased 75.8 

C.    Lamb. 
Fresh: 

Breast  or  chuck 56.2 

Leg,  hind 58.6 

Shoulder 51 .8 

Forequarter 55.1 

Hindquarter 60.9 

Cooked: 

Chops,  broiled 47.6 

Leg,  roast 67.1 

D.    Mutton. 
Fresh: 

Chuck,  lean 64.7 

Leg,  hind 63 .2 

ShovJder 60.2 

Forequarter 52.9 

Cooked: 
Mutton,  leg,  roast 50.9 

E.    Pork. 
Fresh: 

Ham $o.\ 

Pickled,  salted,  and  smoked: 
Ham,  smoked,  boiled,  as  pur- 
chased  51.3 

fried,  as  piurchased 36.6 

Bacon,  smoked 20.2 


Protein.        Fat. 

Per  cent.    Per  cent.    Per  cent. 


Carbohy-    p-i-rie, 

drates.      r?,  i^ 

per  100 


20.3 
20.7 
19.9 
20.2 

19.7 
16.9 


25.0 


II.O 

6.7 

lO.O 

9-4 

14.4 
6.4 


19. 1 

23.6 

18.6 

22.6 

I8.I 

29.7 

18.3 

25.8 

19.6 

I9.I 

21.7 

29.9 

19.7 

12.7 

22.6 


15-7        33-4 


i8s 
146 
174 
170 

21S 
129 


298 
287 
351 
31S 
258 


367 
198 


17.8 

16.3 

225 

18.7 

17-5 

239 

17-5 

21.8 

274 

15-6 

30.9 

352 

313 


375 


20.2 

22.4 

291 

22.2 

33-2 

400 

lO.S 

64.8 

646 

136     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 


Food  Material.  Water. 

F.  Sausage  (as  purchased) .   per  cent. 

Bologna 55.2 

Frankfort 57.2 

Pork 39.8 

sausage  meat 46.2 

G.    Poultry, 
Fresh: 

Chicken,  broiler 69.7 

young,  dark  meat 70.1 

light  meat 70.3 

Duck,  breast 73.9 

Guinea-hen  meat,  not  includ- 
ing giblets 68.9 

Pheasant  meat,  not  including 

giblets 70.0 

Pigeon  meat,  not  including 

giblets 63.2 

Quail    meat,    not    including 

giblets 66.3 

Squabs,  meat,  not  including 

giblets 56.6 

Turkey,  dark  meat 57.0 

cooked 53.7 

light  meat 63 .9 

cooked 58.5 

Preserved  Poultry  Meat: 

Potted  turkey 56.0 

chicken 56.1 

Canned  chicken  soup 87.1 

gumbo  soup 91 .0 

boned  chicken 57.6 

H.    Fish. 
Fresh: 

Cod,  whole 82.6 

Bass,  black,  whole 76.7 

sea,  whole 79.3 

striped,  whole 77.7 

Blackfish,  whole 79.1 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calori 

per  10 

gm. 

18.2 

19.7 

258 

19.6 

18.6 

I.I 

258 

13 -o 

44.2 

I.I 

468 

17.4 

32-5 



374 

20.7 

8.3         .. 

196 

20.8 

8.2 

187 

21.9 

7.4 

184 

22.3 

2.3 

iSi 

23-4 

6.5         :. 

191 

24.7 

4.6        .. 

180 

22.9 

12. 1 

243 

254 

7.0 

208 

18.5 

23-8        .. 

324 

21.4 

20.6 

316 

39-2 

4-3 

26s 

25-7 

9.4 

23s 

34-6 

4.9 

240 

17.2 

22.0 

306 

19.4 

20.3 

306 

2.9 

3-3          S 

.1           66 

2.4 

0.2          4 

•8          35 

27.7 

12.8 

274 

16.S 

0.4 

1.2 

103 

20.6 

1-7 

1.2  • 

103 

19.8 

o-S 

1.4 

86 

18.6 

2.8 

1.2 

102 

18.7 

1-3 

I.I 

89 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS      137 


Water. 
Food  Material. 

Fresh:  ^'"^^^ 

Bluefish,  entrails  removed. .  .78.5 

Butterfish,  whole 70.0 

Eels,  salt  water 71.6 

Haddock,  entrails  removed.  .81.7 
Halibut,  steak  or  sections.  .  .75.4 

Herring,  whole 72.5 

Mackerel,  whole 73.4 

Perch,  white,  whole 75.7 

as  purchased 28.4 

yellow,  whole 79.3 

Pickerel,  pike,  whole 79.8 

Pike,  gray,  whole 80.8 

Pompano,  whole 72.8 

Pogy  (scup),  whole 75.0 

Salmon,  whole 64.6 

Shad,  whole 70.6 

roe,  as  purchased 71 .2 

Smelt,  whole 79.2 

Spanish  mackerel,  whole 68.1 

Trout,  brook,  whole 77.8 

Preserved  and  canned: 

Cod,  salt 53.5 

Herring,  smoked 34.6 

Mackerel,  salt,  dressed 43.4 

Salmon,  canned 63.5 

Sardines,  caimed 52.3 

Shellfish,  etc.,  Fresh: 

Clams,  roimd,  removed  from 

shell,  as  purchased 80.8 

Oysters,  solids,  as  purchased. 88 .3 
Scallops,  as  purchased 80.3 

I.    Eggs, 

Hens',  uncooked 73.7 

boiled 73.2 

whites 86.2 

yolks 49.S 

Egg,  boiled,  i  egg  (50  gm.) .  36.6 


Protein. 
Per  cent. 

Fat         ^roony- 
*"•         drates. 

Per  cent.    Per  cent. 

Calories 

per  100 

gm. 

19.4 

1.2 

1-3 

90 

18.0 

II.O 

1.2 

176 

18.6 

9.1 

I.O 

161 

17.2 

0-3 

1.2 

74 

18.6 

5-2 

1.0 

125 

195 

7.1 

1-5 

146 

18.7 

7-1 

1.2 

142 

193 

4.0 

1.2 

117 

7-3 

i-S 

0.4 

44 

18.7 

0.8 

1.2 

84 

18.7 

o-S 

I.I 

81 

17.9 

0.8 

I.I 

80 

18.8 

7-5 

1.0 

147 

18.6 

5-1 

1.4 

123 

22.0 

12.8 

1.4 

209 

18.8 

9-5 

1-3 

16S 

20.9 

3-8 

1-5 

133 

17.6 

1.8 

1-7 

89 

21.S 

9.4 

1-5 

175 

19.2 

2.1 

1.2 

98 

25-4 

0.3 

90 

36.9 

iS-8 

299 

17-3 

26.4 

316 

21.8 

12. 1 

201 

23.0 

19.7 

278 

10.6 

I.I 

S-2 

75 

6.0 

1-3 

3-3 

SI 

14.8 

0.1 

3-4 

76 

134 

lo.s 

159 

13-2 

12.0 

169 

12.3 

0.2 

55 

15-7 

33-3 

376 

6.6 

6.0 

169 

Total, 

I  egg. 

..  83 

138     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Water. 
Food  Material. 

Per  cent. 

J.    Dairy  Products,  etc. 
(As  Purchased). 

Butter II. o 

Buttermilk 91 .0 

Cheese,  American,  pale 31.6 

red 28.6 

California  flat. 34.0 

Cheddar 27 .4 

Cheshire 37.1 

Cottage 72.0 

Dutch 35.2 

Full  cream 34.2 

Limburger 42.1 

Neuchatel 50.0 

Roquefort 29.3 

Swiss 31.4 

Cream 74.0 

Koumiss 89.3 

Milk,  condensed,  sweetened..  26.9 
unsweetened       (evapor- 
ated cream) 68.2 

skimmed 90.5 

whole 87 .0 

whey 93.0 

K.    Miscellaneous  (As  Pur- 
chased). 

Beef-juice 93.0  4.9  0.6        25 

Calf's-foot  jelly 77.6  4.3         17.4  89 

Oleomargarine 9.5  1.2        83.0        ....         777 

VEGETABLE  FOOD. 
A.    Flour,  Meals,  etc. 

Barley  meal  and  flour 1 1 .9 

Buckwheat  flour 13 .6 

Commeal,  granular 12.5 

Com  Preparations: 

Cerealine 10.3 

Hominy 11 .8 

cooked 79.3 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

L^rDony- 
drates. 

Per  cent. 

Caloriac 

per  100 

gm. 

I.O 

85.0 

795 

3-0 

O.S 

4.8 

36 

28.8 

35-9 

0.3 

453 

29.6 

38.3 

477 

24-3 

33-4 

4-5 

429 

27.7 

36.8 

4.1 

473 

26.9 

30.7 

0.9 

399 

20.9 

1.0 

4-3 

112 

37-1 

17.7 

316 

25-9 

33-7 

2.4 

430 

23.0 

29.4 

0.4 

369 

18.7 

27.4 

i-S 

337 

22.6 

29-5 

1.8 

375 

27.6 

24.9 

1-3 

443 

2-S 

x8.s 

4-S 

201 

2.8 

2.1 

5-4 

53 

8.8 

8.3 

S4.I 

335 

9.6 

9-3 

II. 2 

172 

34 

0-3 

S-i 

37 

3-3 

4.0 

S-o 

72 

1.0 

0-3 

S.O 

28 

lo.s 

2.2 

72.8 

362 

6.4 

1.2 

77-9 

357 

9.2 

1.9 

75-4 

36s 

9.6 

I.I 

78.3 

370 

8.3 

0.6 

79 -o 

364 

2.2 

0.2 

17.8 

84 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     139 

Water.  Protein.  Fat.  ^JL^J^^"  Calorie* 

Food  Material.  <*'»^«»-  per  100 

Per  c«nt.  Per  cent.  Per  cent.  Per  cent.  gm. 

Oatmeal .  .  .  ♦. 7.3  16. i  7.2  67.5  410 

bofled 84.5  2.8  0.5  11.5  63 

gruel 91.6  1.2  0.4  6.3  34 

water 96.0  0.7  o.i  2.9  15 

Rolled  oats 7.7  16.7  7.3  66.2  408 

Rice 12.3  8.0  0.3  79.0  359 

boiled 72.5  2.8  0.1  24.4  112 

flaked 9.5  7.9  0.4  81.9  371 

flour 8.5  8.6  6.1  68.0  370 

Rye  flour 12.9  6.8  0.9  78.7  359 

meal 11.4  13.6  2.0  71.5  367 

Wheat,  entire 11.4  13.8  1.9  71.9  369 

gluten 12.0  14.2  1.8  71. 1  367 

Graham 11.3  13.3  2.2  71.4  368 

Prepared  (self-raising) 10.8  10.2  1.2  73.0  353 

Wheat  Preparations: 

Cracked  and  crushed 10. i  11. i  1.7  75.5  371 

Farina 10.9  ii.o  1.4  76.3  371 

Flaked 8.7  13.4  1.4  74.3  373 

Gems 10.4  10.5  2.0  76.0  374 

Glutens 8.9  13.6  1.7  74.6  378 

Macaroni 10.3  13 .4  0.9  74.1  367 

cooked 78.4  3.0  1.5  15.8  91 

Noodles 10.7  II. 7  i.o  75.6  367 

Shredded 8.1  10.5  i .4  77.9  375 

Spaghetti 10.6  12. i  0.4  76.3  366 

Vermicelli ii.o  10.9  2.0  72.0  358 


B.   Bread,  Crackers,  Pastry, 
ETC.  (As  Purchased). 

Bread: 

Brown 43.6 

Com  (johnny  cake) 38.9 

Rye 3S-7 

Wheat: 

Bims 29.0 

Cinnamon 23.6 

Currant 27.5 


54 

1.8 

47.1 

331 

7-9 

4-7 

46.3 

366 

9.0 

0.6 

53-3 

260 

6.3 

6.5 

57-3 

321 

9.4 

7.2 

59-1 

347 

6.7 

7.6 

57.6 

334 

Protein. 
Per  cent. 

Fat. 
Per  cent. 

i^roony- 
drates. 

Per  cent. 

Calories 
per  100 

gm. 

7.9 

4.8 

49-7 

281 

8.9 

1.8 

52.1 

267 

8.7 

2.6 

55-3 

287 

9-3 

13-7 

52.6 

381 

8.5 

2-5 

SS-7 

287 

8.S 

2.2 

56.5 

287 

8.0 

1.4 

S4-3 

269 

9.1 

1.6 

53-3 

270 

9.2 

1-3 

S3-I 

268 

9-7 

0.9 

49-7. 

251 

9.8 

9.9 

73-5 

434 

140     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Food  Material.  Water. 

VEGETABLE    FOOD.    Percent. 

Bread,  Wheat:  Hot  cross 36.7 

Graham 35.7 

Biscuit,  home  made 32.9 

soda 22.9 

Rolls,  French 32.0 

Vienna 31.7 

White,  biscuit 35.2 

home-made 35.0 

all  analyses 35.3 

Whole  wheat 38.4 

Zwieback 5.8 

Crackers: 

Soda 5.9  9.8  9.1  73.1  424 

Boston  (split) 7.5  ii.o  8.5  71. i  416 

Egg 5.8  12.6  14.0  66.6  454 

Graham 5.4  lo.o  9.4  73.8  429 

Oatmeal 6.3  11. 8  11. i  69.0  434 

Oyster 4.8  11.3  10.5  70.5  433 

Pretzels 9.6  9.7  3.9  72.8  375 

Saltines 5.6  10.6  12.7  68.5  442 

Water 6.4  11. 7  5.0  75.7  405 

All  analyses 6.8  10.7  8.8  71.9  420 

Cake: 

Bakers' 31.4  6.3  4.6  59.9  302 

Chocolate  layer 20.5  6.2  8.1  64.1  364 

Drop 16.6  7.6  14.7  60.3  316 

Frosted 18.2  5.9  9.0  64.8  374 

Fruit 17.3  5.9  10.9  64.1  388 

Gingerbread 18.8  5.8  9.0  63.5  368 

Sponge 15.3  6.3  10.7  65.9  396 

Cookies,  Cakes,  etc.: 

Mollasses  cookies 6.2  7.2  8.7  75.7  421 

Sugar  cookies 8.3  7.0  10.2  73.2  423 

Ginger  snaps 6.3  6.5  8.6  76.0  418 

Lady  fingers 15.0  8.8  5.0  70.6  371 

Macaroons 12.3  6.5  15.2  65.2  435 

Doughnuts 18.3  6.7  21.0  53.1  441 


CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS      141 


Water. 
Food  Material, 
pjg.  Percent. 

Apple 42.5 

Cream 32.0 

Custard 62.4 

Lemon 47 .4 

Mince. .'. 41 .3 

Squash 64.2 

Puddings: 

Rice  custard 59.4 

Indian  meal 60.7 

Tapioca 64.5 

Tapioca  with  apple 70.1 

Ice-cream 66.9 

C.     Sugars,  Starches,  etc. 
(As  Piu'chased) 

Candy 

Honey 18.2 

Mollasses,  cane 25.1 

Starch,  tapioca 11. 4 

Sugar,  coffee  or  brown 

granulated 

maple 

powdered 

D.    Vegetables. 

Artichokes,  as  purchased 79.5 

Asparagus,    cooked,     as    pur- 
chased  91 .1 

Beans,  butter,  green 58.9 

String  beans,  cooked 95.3 

fresh,  as  purchased 83.0 

Beets,  cooked 88.6 

Cabbage 91.5 

Carrots,  fresh 88.2 

Cauliflower,  as  purchased 92.3 

Celery 94.5 

Com,  green 75,4 

Cucumbers 95.4 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

L-aroony- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

3-1 

9.8 

42.8 

280 

4.4 

II.4 

SI.2 

334 

4.2 

6.3 

26.1 

183 

3.6 

10. 1 

37-4 

262 

5-8 

12.3 

38.1 

294 

4.4 

8.4 

21.7 

i8s 

4.0 

4.6 

31-4 

182 

s-s 

4.8 

27-5 

180 

3-3 

3-2 

28.2 

159 

0-3 

0.1 

29-3 

122 

5-2 

lO.I 

17.7 

189 

96.0 

391 

0.4 

81.2 

335 

2.4 

69.3 

284 

0.4 

0 

I         88.0 

364 

.. 

95 -o 

389 

lOO.O 

410 

82.8 

339 

.. 

lOO.O 

410 

2.6 


16.7 


80 


2.1 

.3-3 

2.2 

48 

9.4 

0.6 

29.1 

163 

0.8 

I.I 

1.9 

21 

2.1 

0.3 

6.9 

40 

2.3 

0.1 

7-4 

41 

1.6 

0.3 

5-6 

32 

I.I 

0.4 

9-3 

46 

1.8 

0.5 

4-7 

31 

I.I 

0.1 

3.3 

19 

3-1 

I.I 

19.7 

104 

0.8 

0.2 

3-1 

18 

142     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 


Food  Material.  Water. 

VEGETABLE    FOOD.    Percent. 

Eggplant 92.9 

Greens,  beet,  cooked,  as  pur- 
chased  89.5 

Lentils,  dried,  as  purchased. ...  8.4 

Lettuce 94.7 

Mushrooms,  as  purchased 88.1 

Okra 90.2 

Onions,  fresh 87.6 

prepared,  as  purchased 91.2 

Parsnips 83.0 

Peas,  dried,  as  purchased 9.5 

green 74.6 

cooked,  as  purchased 73.8 

Potatoes,  raw  or  fresh  cooked. .  78.3 

boiled,  as  purchased 75.5 

cooked  chips,  as  purchased . .   2.2 
mashed   and   creamed,   as 

purchased 75.1 

sweet,  raw  or  fresh 69.0 

cooked   and  prepared,  as 

purchased 51 .9 

Pimipkins 93.1 

Radishes 91 .8 

Rhubarb 94.4 

Sauerkraut,  as  piu-chased 88.8 

Spinach,  fresh,  as  purchased.  .  .92.3 

cooked,  as  purchased 89.8 

Squash 88.3 

Tomatoes,  fresh,  as  purchased .  .94.3 
Turnips *. 89.6 

Canned  as  Purchased. 

Asparagus 94-4 

Beans,  baked 68.9 

string 93.7 

lima 79.5 

red  kidney 72.7 

Brussels  sprouts 93.7 

Com,  green 76.1 

Okra 94.4 


Protein.         Fat.        ^^tt^'  Calorie, 
per  100 
Per  cent.    Per  cent.    Per  cent.        gm. 


1.2 


03 


S-I 


29 


2.2 

3-4 

3-2 

54 

25-7 

1.0 

59-2 

357 

1.2 

0.3 

2.9 

20 

3-5 

0.4 

6.8 

46 

1.6 

0.2 

7-4 

39 

1.6 

0.3 

9.9 

49 

1.2 

1.8 

4.9 

42 

1.6 

o-S 

13-5 

66 

24.6 

1.0 

62.0 

36s 

7.0 

o-S 

16.9 

102 

6.7 

3-4 

14.6 

119 

2.2 

0.1 

18.4 

85 

2-5 

0.1 

20.9 

97 

6.8 

39-8 

46.7 

589 

2.6 

3-0 

17.8 

III 

1.8 

0.7 

27.4 

126 

30 

2.1 

42.1 

204 

I.O 

0.1 

5-2 

26 

1-3 

0.1 

5.8 

30 

0.6 

0.7 

3.6 

23 

1-7 

0.5 

3.8 

28 

2.1 

0.3 

3-2 

24 

2.1 

4.1 

3.6 

57 

1.4 

o-S 

9.0 

47 

0.9 

0.4 

3-9 

23 

1-3 

0.2 

8.1 

41 

1-5 

0.1 

2.8 

19 

6.9 

2-5 

19.6 

132 

I.I 

O.I 

3-8 

21 

4.0 

0-3 

14.6 

79 

7.0 

0.2 

18.S 

106 

I -5 

0.1 

3-4 

21 

2.8 

1.2 

19.0 

103 

0.7 

0.1 

3-6 

19 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS      143 


Water. 
Food  Material. 

Per  cent. 

Peas,  green 85.3 

Piunpkins 91 .6 

Squash 87.6 

Succotash 75 .9 

Tomatoes 94.0 

F.    Fruits,  Bemoes. 
Apples: 

Edible  portion 84.6 

As  purchased  (refuse,  25.0).  .63.3 

Apricots 85.0 

Bananas: 

Edible  portion 75.3 

As  purchased  (refuse,  35.0).  .48.9 

Blackberries,  as  purchased 86.3 

Cherries,  as  purchased 76.8 

Cranberries,  as  purchased 88.9 

Currants,  as  purchased 85.0 

Figs,  fresh,  as  purchased 79.1 

Grapes,  as  purchased 58.0 

Huckleberries 81 .9 

Lemons: 

Edible  portion 89.3 

As  purchased  (refuse,  30.0).  .62.5 

Muskmelons: 

Edible  portion 89.5 

As  purchased  (refuse,  50.0).  .44.8 

Nectarines 82 .9 

Oranges: 

Edible  portion 86.9 

As  purchased  (refuse,  27.0).  .63.4 

Peaches: 

Edible  portion 69.4 

As  purchased  (refuse,  18.0).  .73.3 

Pears: 

Edible  portion 64.4 

As  purchased  (refuse,  lo.o).  .76.0 

Pineapple 89.3 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

carDony- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

3-6 

0.2 

9.8 

S6 

0.8 

0.2 

6.7 

33 

0.9 

O-S 

lo.s 

52 

3.6 

I.O 

18.6 

103 

1.2 

0.2 

4.0 

23 

0.4 

0.5 

14.2 

64 

0-3 

0-3 

10.8 

49 

I.I 

134 

59 

1-3 

0.6 

22.0 

lOI 

0.8 

0.4 

14-3 

66 

1-3 

1.0 

10.9 

15 

0.9 

0.8 

15-9  • 

76 

0.4 

0.6 

9.9 

47 

1-5 

12.8 

58 

1-5 

18.8 

84 

1.0 

1.2 

14.4 

74 

0.6 

0.6 

16.6 

76 

1.0 

0.7 

8.5 

45 

0.7 

0.5 

S-9 

32 

0.6 

9-3 

41 

0.3 

4.6 

20 

0.6 

.... 

15-9 

67 

0.8 

0.2 

11.6 

S3 

0.6 

0.1 

8.5 

37 

0.7 

0.1 

9.4 

42 

o-S 

0.1 

7-7 

34 

0.6 

o-S 

14. 1 

65 

o-S 

0.4 

12.7 

57 

0.4 

0-3 

9-7 

44 

Fat. 
er  cent. 

drates. 
Per  cent. 

Calories 

per  100 

gm. 

..  .  . 

18.9 

81 

12.6 

56 

0.6 

7-4 

40 

0.2 

6.7 

31 

O.I 

2.7 

13 

2.2 

66.1 

298 

I.O 

62.5 

284 

1-5 

78.1 

336 

1-7 

74.2 

330 

2.8 

78.4 

33(> 

0.3 

74.2 

325 

S-4 

72.9 

360 

73-3 

309 

3-3 

76.1 

354 

144     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Food  Material.                   Water.  Protein. 

VEGETABLE    FOOD.    Percent.  Percent. 

Prunes 79.6  0.9 

Raspberries,  as  purchased 85 .8  i  .0 

Strawberries 90.4  1.0 

Watermelons: 

Edible  portion 92.4  0.4 

As  purchased  (refuse,  59.4).  .37.5  0.2 

Dried. 

Apples,  as  purchased 28.1  1.6 

Apricots,  as  purchased 29.4  4.7 

Citron,  as  purchased 19.0  0.5 

Currants,  as  purchased 17.2  2.4 

Dates 15.4  2.1 

Figs,  as  purchased 18.8  4.3 

Pears 16.5  2.8 

Prunes 22.3  2.1 

Raisins. .  .■ 14.6  2.6 

Canned  and  Jellies. 
Preserves,  etc.,  as  purchased: 

Apples,  crab 42.4  0.3 

sauce 61. 1  0.2 

Apricots 81 ,4  0.9 

Blackberries 40.0  0.8 

Blueberries 85.6  0.6 

Cherries 77.2  i.i 

Figs,  stewed 56.5  1.2 

Marmalade  (orange  peel). .  . .  14.5  0.6 

Peaches 88.1  0.7 

Pears 81. i  0.3 

Strawberries,  stewed 74.8  0.7 

Prune  sauce 76.6  0.5 

G.    Nuts. 

Almonds 4.8  21.0 

Beechnut 4.0  21 .9 

Brazil    nuts    (Bertholletia    ex- 

celsa),  edible  portion 5.3  17.0 

Butternuts: 

Juglans cinerea 4.4  27.9 


2.4 

54-4 

247 

0.8 

37-2 

161 

17-3 

75 

2.1 

56.4 

254 

0.6 

12.8 

61 

O.I 

21. 1 

91 

0.3 

40.9 

173 

O.I 

84-5 

349 

O.I 

10.8 

49 

0-3 

18.0 

78 

24.0 

lOI 

0.1 

22.3 

95 

54-9 

17-3 

668 

57-4 

13.2 

678 

66.8 

7.0 

720 

61.2 

3-5 

698 

Protein. 
Percent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Caloric 

per  101 

gm. 

6.2 

54 

42.1 

246 

S-2 

4-5 

35-4 

208 

S-7 

50.6 

27.9 

608 

6.3 

57-4 

3^-5 

689 

IS.6 

6S-3 

130 

72s 

154 

67.4 

II.4 

737 

2.9 

0.2 

77-5 

332 

25-8 

38.6 

24.4 

564 

19-5 

29.1 

18.5 

427 

29-3 

46-5 

17.1 

623 

18.4 

64.4 

13-0 

728 

12.9 

48.7 

30.3 

631 

21.6 

28.9 

37-7 

S" 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     145 

Food  Material.  Water. 

Chestnuts:  Percent. 

Edible  portion 45.0 

As  purchased  (refuse,  16.0).  .37.8 

Cocoanuts 14.1 

Cocoanut,    prepared,"  as   pur- 
chased   3.5 

Filberts 3.7 

Hickory  nuts 3.7 

Lichi  nuts 17.9 

Peanuts: 

Edible  portion 9.2 

As  purchased  (refuse,  24.5). .  6.9 

Peanut  butter,  as  purchased. . .  2.1 

Walnuts,  California 2.5 

H.    Miscellaneous. 

Chocolate 5 .9 

Cocoa 4.6 

UNCLASSIFIED  FOOD 

MATERIALS. 
Animal  and  Vegetable. 
A.    Soups. 
Home  Made  (As  Purchased). 

Beef 92.9 

Bean 84.3 

Chicken 84.3 

Chowder,  clam 88.7 

Meat  stew 84.5 

Canned  (As  Purchased). 

Asparagus,  cream  of 87.4 

Bouillon 96.6 

Celery,  cream  of 88.6 

Chicken 93.8 

gumbo 89.2 

Consomm6 96.0 

Com,  cream  of 86.8 

JuUenne 95 .9 

Mock  turtle 89.8 


4-4 

0.4 

I.I 

26 

3-2 

1.4 

94 

6S 

10.5 

0.8 

2.4 

6i 

1.8 

0.8 

6.7 

43 

4.6 

4.3 

5-5 

81 

2.S 

3.2 

5.5 

63 

2.2 

O.I 

0.2 

II 

2.1 

2.8 

5.0 

55 

3.6 

O.I 

i-S 

22 

3.8 

0.9 

4.7 

43 

2-5 

— 

0.4 

12 

2.5 

1.9 

7.8 

59 

2.7 

o.S 

13 

S.2 

0.9 

2.8 

41 

146     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Food  Material.  Water. 

UNCLASSIFIED    FOOD      Percent. 
MATERIAL. 

Mulligatawny 89.3 

Oxtail 88.8 

Pea 86.9 

cream  of  green 87.7 

Tomato 90.0 

Turtle,  green 86.6 

Vegetable 95.7 

B.    Miscellaneous. 

Hash 80.3 

Mincemeat,  commercial 27.7 

home-made 54.4 

Salad,  ham 69.4 

Sandwich,  egg 41 .4 

chicken 48.5 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calori< 

per  10 

gm. 

3-7 

O.I 

5-7 

40 

4.0 

1-3 

4-3 

46 

3-6 

0.7 

7.6 

52 

2.6 

2.7 

5-7 

60 

1.8 

I.I 

5.6 

41 

6.1 

1.9 

3-9 

58 

2.9 

.... 

o-S 

14 

6.0 

1.9 

9.4 

80 

6.7 

1.4 

60.2 

288 

4.8 

6.7 

32.1 

214 

iS-4 

7.6 

5.6 

157 

9.6 

12.7 

34-5 

299 

12.3 

5-4 

32.1 

232 

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STANDARD  PORTIONS 


153 


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154  I-IST   OF  FOODS 

LIST  OF  FOODS,  THEIR  COMPOSITION,  CALORIC  VALUE » 


Food 


Gm. 
amt. 


Oz. 


Pro. 


Fat 


CH. 


Rough  measure 


Cal- 
ories 


Huckleberries. 
Lemon  juice.. 
Lemon  juice. . 
Muskmelon. . . 


Pears 

Prunes,  dried. . 
Raisins,  dried. 
Nectarines. . .. 

Pineapple 

Plums 

Raspberries. . . 
Watermelon. . , 
Apricots 


Nuts 

Almonds 

Brazil  nuts. . . 
Chestnuts 


Cocoanuts. 
Filberts..., 
Peanuts. . . 
Pecans. . . . 
Pistachios . 
Walnuts. . . 


Meats 
Chicken,  broiler. 
Chicken,  fowl. .  . 
Chicken,  fowl. . . 


Chicken,  fowl. 


Squab. 


Round  steak. 


Porterhouse  steak. 

Tenderloin 

Sirloin 

Top  sirloin 

Roast  beef 


100 

IS 

100 
100 

100 
100 
100 
lOO 
100 
100 
100 

270 

100 


100 

100 


100 
100 
100 
100 


2.6 


0.6 

0.6 
2.0 
2.0 
0.4 
0.4 

I.O 
I.O 

I.I 


3-1 
10.2 
2.6 

1.9 

4.8 
5.8 
3.3 

I.I 

7.7 


21-5 

19.0 
17.6 

17.6 


16.2 
6 
19. S 
23.0 

22.0 

21.9 
16.2 
19. 1 
13.8 
18.0 


0.6 


0.5 


30 
0.5 
0.3 


o.S 


40.1 


17.2 

14.2 

8.7 

1-3 

2.7 

27.0 


2.5 
16.3 
II. S 

7.6 


36.2 
a. 8 
7-3 
2.S 


2.5 

20.4 
24.4 
18.0 
43-7 
28.6 


16.0 
1-5 

10. o 
9.0 

14 

73 

76.0 
14 
10. o 

20.0 
12  .0 
18.0 

iS.o 


2.6 

4.2 
17.7 

95 
3-9 

5-5 
4.0 
0.8 
S-S 


4  Tablespoons 
I  Tablespoons 
H  glass 

Edible  portion,  H  av. 
size 
I  average 


1  average 

2  av.  slices 
2  av.  size 

4  Tablespoons 

1  large  slice 

2  av. 


10  large 
10  large 

Roasted,  i  handful  or 
20  nuts 

I  slice  2  X  2  X  M 
10  nuts 

I  handful,  15  nuts 
10  large 
10  large 
ID  large 

Roasted,  av.  serving 
Roasted,  av.  serving 
Boiled    av.     hospital 

diabetic  chicken 
Boiled    3     hr.     after 

skimming,    remove 

fat 

Av.  size 

Very  lean,  av.  serving 
Lean,  av.  serving 
Free  from  all  visible 

fat 
Scraped     fat-free,     2 

patties 

Av.  serving  3J^, 
2  X  2  X I  in. 


73-0 

6.0 

41 .0 

39  O 

65.0 
308.0 
348.0 
64.0 
45-0 
86.0 
S3  o 
83.0 
71.0 


100.  o 
432.0 
104.0 

207.0 
216.0 
128.0 
229.0 
33.0 
306.0 


IIO.O 

230.0 
180.0 


325.8 

120.0 

148.0 

118. o 

IIO.O 

270. s 
293.0 
24s.  o 

463.2 
339.8 


^  Prepared  by  Geyelin.     Foster  from  Atwater  and  Bryant  as  basis. 


LIST  OF   FOODS 


ISS 


LIST  OF  FOODS,  THEIR  COMPOSITION,  CALORIC 

VALUE— (Continued) 


Food 


Gm. 

amt. 


Oz. 


Pro. 


Fat 


CH. 


Rough  measure 


Cal- 
ories 


Cereals,  Bread,  Etc. 
Bread,  white 

Bread,  white 

Breakfast  roll 

Vienna- French  roll. . . 

Triscuit 

Zweibach 

Graham  cracker 

Saltine 

Uneeda  biscuit 

Shredded     wheat 

biscuit 

^i  milk  oatmeal  gruel 

H  thin  oatmeal 

Oatmeal 

Cream  of  wheat 

Farina 

Rice 

Fish 

Oysters 

Salmon,  fresh 

Salmon,  canned 

Blue  fish 

Cod  fish 

Halibut 

Mackerel 

Sardines 

Fruits 

Orange 

Orange  juice 

Grapefruit 

Strawberries 

Peach 

Apple 

Banana 

Blackberries 

Cherries 

Cranberries 

Currants 

Figs,  dried 

Grapes 


9 

4 
7 

30 
100 

i8o 

100 


100 
100 
100 
100 
100 
100 
100 
100 

100 
100 
100 


100 
100 
100 
100 
100 
100 
100 
100 
100 


3H 


3M 

3!4 

3H 
3H 
3H 

3H 
3H 
3H 

3H 
3H 
3M 

3H 

3H 
3H 
3H 
3H 
3H 
3H 
3H 
3H 
3H 


2.9 

3-9 
3-9 
53 

1.2 

0.8 
I.O 

0.4 
0.7 

3-1 
3.1 
IS 

3.8 


3.0 
3-0 


6.2 

22.0 
21.8 
2S.9 
21.7 

I9-S 
i8.0 
23.0 

0.8 
0.8 


0.7 
0.4 
1.0 
1.0 
O.I 

0.4 

1.0 

4.0 

I  .0 


O.I 
O.I 

i.S 

O.I 

0.8 

1.0 
O.S 

0.6 
0.4 

3-5 
0.5 

1-4 


0.2 
0.2 


1.2 
12.8 
12. 1 

4-S 
2.1 
5-7 
6.8 

19.7 

0.2 
0.2 


0.6 

0.1 
O.S 
0.6 
0.1 


0.6 


16.  oj 

21.0 
21. I 
35.2 
9.4 
6.1 
7.0 
3.0 
S.I 

23.6 
4-7 
7 

17.8 


I  slice  medium,  3H  X 
3HXH- 
I  slice,  thick 


3XiXj^  in. 

I 


19. 1 
18.8 


3.7 


I  glass 
I  glass 

5  T  or  ?s  gm.  wgd.  dry, 
cooked  c,  100  c.c.  H2O 
or  H  cup,  3  T. 

[  4  T  or  25  gm.  dry  in  1 
\  ISO    c.c.  =  J.4    cup 
l=4T. 

3  round  T.  or  25  gm 
100  c.c.  H20  =  3  T. 

6  large  =  8  small 

1  slice  3HX2HXH 

3  heaping  T. 

Av.  serving 

Av.  serving 

Av.  serving 

Av.  serving 

5  large  =  9  small 


1 1 . 6    I  small. 
1 1  •  6   H  glass 

S .  0    H  large  or  i  small  or 
}4  glass. 

7.0   2  heaping  T.  or  6  large 
berries. 

9.0    I  av. 

14.0    I  av.  edible  portion 
22.0    I  av. 
1 1 .  o   3  Tablespoons 
15.0    18  cherries 
10. o   3  Tablespoons 
13.0   s  Tablespoons 
74. o|  5  Figs 
14.0   20  av. 


70.0 

102.0 
102.0 
180.0 
4S.0 
36.0 
42.0 
29.0 
18.0 

1 13.0 
102.0 
102.0 
101.6 


92.5 
91-3 


52.2 
209.0 
202.0 

IS8.0 

91.5 
130.2 
137.0 

277. 5 

So.o 

50.0 

205.0 

38.0 

41 .0 
64.0 

100.  o 
S9.0 
71.0 
48.0 
57.0 
71.0 

323.0 


IS6 


LIST  OF  FOODS 


LIST  OF  FOODS,  THEIR  COMPOSITION,  CALORIC  VALUE 

{Continued) 


Food 


Gm, 
amt. 


Oz. 


Pro. 


Fat 


CH. 


Rough  measure 


Cal- 
ories 


Canned  Vegetables 

Artichokes 

Asparagus 

String  beans 

Wax  beans 

Lima  beans 

Red  kidney  beans. . 

Brussel  sprouts 

Corn 

Peas 

Pumpkin 

Squash 

Succotash 

Tomato 


Dairy  Products 

Egg,  white 

Egg,  yoke 

Cottage  cheese. . . 
American  cheese. . 
Neufchatel  cheese. 

Butter 

Butter 

Butter 


Cream,  19  % 

Cream,  38  % 

Cream  Sheffield. . . , 

Cream,  19% 

Milk 

Butter  milk 

Pat-free  milk 

Dry  malted  milk. . 
Hortons  ice-cream. 

Whey 

Whey 

Junket 

Baked  custard 


Alcohol 


Sherry.. 
Brandy. 
Whisky. 
Rum . . . 
Gin 


3H 
3H 
3H 
3H 

3H 
3M 
3H 
3H 
3H 
3J^ 
3M 
3H 


0.8 
I.S 
I.I 

I.O 

4.0 
7.0 

I.S 
2.8 
3.6 
0.8 
0.9 
3.6 


3-1 

2.6 

8.6 

14.0 


0.1 
0.1 
0.3 
0.2 
0.1 


0.2 
0.2 
o.S 
0.2 
0.2 


5-0 
2.6 
3.8 
3.1 

14.6 

18. S 
3.4 

19.0 
9.8 
6.7 

10.5 
9.8 
4.0 


17.5 


30 
30 
100 
100 
100 
100 
100 
7 
100 

108 
IS 

I«0 
100 


H 


22 


0.8 
0.8 
6 
2.6 
3.1 
35 
35 
1.0 
4.0 
1.8 
0.1 
3-1 
S-4 


25.0 
12.7 
8.5 

5-7 
II. 4 
38.0 
190 
35 
O.os 
O.OS 
0.6 
6.4 
0.5 


35 
5.8 


cohol 


1.4 

1.4 

2.4 

4.6 

4-7 

3-2 

5-0 

4-7 

23.4 

9.3 

0.7 

10. o 

10.  o 


I  av. 

5  stalks  or  3  T. 

3T. 

3T. 

3T. 

2T. 

3T. 

3T. 

3T. 

3T. 

3T. 

3T. 

3T. 


I  av. 

icubeiHXlJ^XiJ^ 
I  piece  iH  X  iH  X I  in. 
I  piece  2  X  iH  X I J4  in. 
I  rounding  T. 
I  level  T. 

I    piece    I  X I  X  ^  = 
I  lev. 

I  single  serving. 
I  single  serving. 
H  glass. 
Ji  glass. 
H  glass. 

Walker-Gordon  >^  glass 
Walker- Gordon  J^  glass 
I  T.  =■  I  teaspoon 
Av.  serving  =  H    cup 
I  glassful  —  I  large  cup 
I  T. 
3T. 
3T. 


2T. 

2T. 
2T. 
2T. 
2T. 


23.8 
18. s 
21.0 
17.7 
79.0 

106.2 
21.0 

100.6 
57.0 
32.5 
Si-3 
57-0 
23.2 

76.4 

63.0 

42.2 

224.4 

168.5 

237.1 

118. o 

79.0 

61.9 
120.0 

3740 
206.0 
64.0 
27-9 
35-3 
28.9 
172 .0 

42.3 

30 

85.0 

117. 0 


30.0 
98.0 
87.0 
95-0 
70.0 


LIST   OF  FOODS 


157 


LIST  OF  FOODS,  THEIR  COMPOSITION,  CALORIC  VALUE 

{Continued) 


Food 


Gm. 
amt, 


Oz. 


Pro. 


Fat 


CH. 


Rough  measure 


Cal- 
ories 


Lamb  chops 

Lamb  chops 

Lamb  roast 

Lamb  roast 

Lamb  roast 

Veal  breast 

Tongue,  cold 

Smoked  ham 

Smoked  ham 

Sweetbread 

Pork  chops 

Guinea  hen 

Bacon 

Bacon,  medium  fat 

Bacon,  lean 

Bacon,  medium  fat 
Turkey 

Miscellaneous 

Sugar 

Chocolate 

Gelatin 

Olive  oil 

Beef  broth 

Beef  juice 

Lactose 

Peanut  butter 

Tomato  catsup. . . . 

Cube  sugar 

Domino  sugar 

Granulated  sugar. . 
Powdered  sugar. . . 

Maple  sugar 

Honey 

Maple  sugar 


100 

30 

100 

100 

2S 

75 

100 

100 
100 
100 
100 
100 
10 


IS 

28.7 

8 

IS 

180 

100 


3H 


H 


93 

18.7 

19.0 

S-7 

19.0 

21.0 

4.9 

IS-2 
14.9 

17.6 
18.4 
26.7 

IS-S 
9.S 
1-5 
I.O 

21.0 


4.0 
7-3 


3.8 


3H 


29-3 
3 


14.2 
28.3 

20.6 
6.2 

16. S 
8.0 
S.8 

16.8 

28. S 

13.3 

390 

70 

42.6 

67.4 

4-3 

6.8 

2.9 


14.0 
13.6 


46. S 


3H 


iS-o 

8.7 


8.0 

17. 1 

2.5 

7.0 

6.0 

10. o 

12.0 

82.8 

24.4 

21.4 


I  French  chop,  bone 
and  some  fat 
3  large  c  all  bone  and 
visible  fat  removed 
Breast  av.  serving 
I  thin  slice 
I  medium  slice  (leg) 
I  large  slice 
I  medium  slice 
I     large    slice,     cold 
boiled 

I  medium  slice,  bone- 
less raw 
Av.  serving 
Av.  chop 

Edible  portion  9  av.  slices 
Edible  portion  9  av.  slices 

I  thin  slice  1X3  in. 

I  thin  slice  1X3  in. 

Av.  serving 


I  level  T. 
I  square 
iT. 
iT. 
I  cup 

H    glass    from    lean 
steak 
I  T. 


I  T. 
I  cube 
I  domino 
I  heaping  T. 
I  heaping  T. 
I  cake 
I  T. 
iT. 


170.3 
329.8 

269.9 
81.0 

232.0 

161.0 
74-0 

218. S 

326.0 

195-9 
438.0 

459.7 

667.4 

46.0 

67.0 

299-4 


61.0 
183.3 
30.0 
126.5 
4-9 
5.6 

33.0 
622.3 
10. 1 
28.7 
24.6 
41.0 
49.3 
339.4 

lOI.O 

88.0 


158 


LIST    OF   FOODS 


LIST  OF  FOODS,  THEIR  COMPOSITION,  CALORIC  VALUE 

(Continued) 


Food 


Gm 

amt. 


Oz. 


Pro. 


Fat 


CH. 


Rough  measure 


Fresh  Vegetables 

Artichoke 

Asparagus 

Butter  beans , 

Lima  beans 

String  beans 

Beets 

Cabbage 

Carrots 

Cauliflower 

Celery 

Cora 


Cucumber 

Egg  plant 

Beet  greens 

Dandelion  greens. . , 
Lettuce 


Mushrooms. . . . 
Onions,  raw. . . . 
Onions,  cooked. 


Parsnips 

Green  peas 

Potato,  sweet 

Potato,  boiled 

Potato,  baked 

Pumpkins 

Radishes 

Rhubarb 

Sauerkraut 

Spinach,  fresh 

Squash 

Tomatoes,  raw 

Tomatoes,  cooked... 

Turnips 

Olives,  green 

Olives,  green 

Olives,  ripe 

Brussel  sprouts 


lOO 
lOO 
100 
100 
100 
100 
100 
lOO 
100 
100 
100 

100 
100 
100 
100 
100 

100 
100 
100 

100 
100^ 
100 
100 
100 
100 
100 
100 
lOO 
100 
100 
lOO 
100 
100 
100 
10 
100 
100 


3M 
3H 
3H 
3H 
3H 
3H 
3H 
3}4 
3H 
3H 
3H 

3H 
3H 
3H 
3H 
3H 

3H 
3H 
314 

3H 
3M 
3H 
3H 
3]^ 
3H 
3H 

iH 

syi 

3H 
3H 

3>i 

3i4 
3H 

3}^ 
3H 


2.6 
1.8 
9-4 
7-1 
2.3 
23 
1.6 
I.I 
1.8 


3-1 
0.8 

1.2 
2.2 
2.4 
1.2 

3-0 

1.6 


1.6 
7.0 


2.5 


1.0 
1.3 
0.6 
17 

2.1 

1-4 

0.9 

0.9 

1-3 

0.8 

0.07 

1-4 

1.4 


0.2 
0.2 
0.6 
0.7 

0.3 
O.I 
0.3 
0.4 
O.S 
O.I 

I.I 

0.2 
0.3 
34 
I.O 
0.3 

0.4 
03 
0.4 

O.S 
O.S 
0.7 
O.I 
O.I 
O.I 
O.I 
0.7 
O.S 
03 
O.S 
0-4 
0.4 

0.2 
20.2 

1.8 
21.0 


i6.7 

3-3 

29.1 

22.0 


7 
9 
5 
9 

4-7 
3-3 
19.7 

3.1 
S.I 
3-3 
10.6 
2.9 

7.0 
9.9 
4-9 

13.  S 
16.0 
27.0 
20.9 


18.4 

S.2 

5.8 
3.6 
3.8 
3-2 
9.0 
3.9 
3.9 
8.1 
8.5 


I  small 

3  T.  cooked  or  g.  stalks 

3  heaping  T. 

3  heaping  T. 

1  heaping  T. 

I  av.  size  or  3  cut  up 

3T. 

3T. 

3T. 

6  stalks  4^  in.  long 

3  heaping  T.  cut  off  «■ 
1  small 

4  T.  sliced 
3  av.  slices 
3  T.  cooked 
3  T.  cooked 

8  medium  leaves  — J^ 
small  head 
4T. 

1  large  or  2  small 

2  heaping  T.  or  2  in. 
onions 

3  T.  or  I  small  parsnip 
3T. 

I  small 

I  medium 

I  medium 

3T. 

12  av.  size 

3  heaping  T. 

3T. 

Cooked  3  heaping  T. 

3T. 

I  small  tomato 

3T. 

3T. 

12  large  =•  22  small 

I  large 

As  purchased 

3  T. 


List  prepared  by  Geyelin  and  Foster  £rom  Atwater  and  Bryant  as  a  basis. 


INDEX 


Akoll  biscuit,  125 

Alcoholic  beverages,  composition 

and  caloric  value,  156 
Allen,  99,  loo 

treatment  for  diabetes,  Joslin's 
r6sum€,  103 
Ambulatory  cases  of^peptic  ulcer, 

diet  for,  66 
Analysis    of    Wright's    diabetic 

milk,  126 
Anasarca,  Karell  treatment  for,  53 
Anticonstipation  breakfast,   132, 

133 
diet,  comments  on,  83 
No.  I,  81 
No.  2,  82 
Arteriosclerosis,  diet  in,  52 
Artificial  buttermilk,  129 
Atwater  and  Bryant,  134,  158 
Auto-intoxication,  intestinal,  diet 
for,  No.  I,  83 
No.  2,  84 
Average  chemical  composition  of 
American  foods,  134 
weights  for  men  and  women, 
19,  133 

Bean,  black,  soup,  128 

Beef,   chemical   composition   of, 

134,  147,  148 
Berries,  chemical  composition  of, 

143,  151 
Biscuits,  bran,  raised,  127 
diabetic,  125 


Bishop,  52 

Black  bean  soup,  128 

Bovaird,  121 

Bran  biscuits,  raised,  127 

crackers,  127 
Bread,  chemical  composition  of^ 
139,  140,  149 

composition  and  caloric  value,. 

iSS 
diabetic,  125 
Breakfast,  anticonstipation,  132 
Bulletin,    Department    of    Agri- 
culture, 134 
Buttermilk,  artificial,  129 


Calcium,    fixed    nitrogen,    mag- 
nesium diet,  121 

Caloric  needs,  19 
value,  19 
of  foods,  154 

Calorie  diet,  five  thousand,  119 

Canned   vegetables,   composition 
and  caloric  value,  156 

Cannon,  64 

Carbohydrate  content  of  foods, 
98 

Cardiac  diets,  comments  on,  54 
diseases,  diet  in,  52 

Carlsbad  water,  61 

Casoid  biscuit,  125 

Celestine  Vichy,  60 

Cereals,  chemical  composition  of, 
149 


159 


i6o 


INDEX 


Cereals,  composition  and  caloric 

value,  155 
Chemical  composition  of  foods, 

134 
Children,  two  to  five  years,  con- 
valescent, diet  for,  122 
convalescing  from  diar- 
rheal diseases,  diet  for, 
123 
Coleman,  33,  37 

Comments    on    anticonstipation 
diets,  83 
on  cardiac  diets,  54 
on  convalescent  diet,  27 
on  diabetic  diets,  99 
on  five  thousand  calorie  diet, 

120 
on  fluid  diet,  28 
on  gastric  diets,  74 
on  intestinal  auto-intoxication 

diet,  85 
on  low-calcium  diet,  121 
on  milk  diet,  28 
on  miscellaneous  recipes,  131 
on  obesity  diets,  116 
on  pneumonia  diet,  40 
on  purin-free  diets,  113 
on  regular  diet,  27 
on  salt-poor  diets,  50 
on    Schmidt's    intestinal    test 

diet,  91 
on  soft  diet,  27 
on  test  meals,  78 
on  typhoid  fever  diet,  36 
Composition  of  foods,  154 
Conner,  L.  A.,  35 
Constipating  diet,  88 
Convalescent  children's  diet,  two 
to  five  years,  122 
from  diarrheal  dis- 
eases, 123 
diet,  24 


Convalescent  diet,  comments  on, 
27 
gastric  diets,  No.  i,  72 
No.  2,  73 
Crackers,  bran,  127 
chemical  composition  of,  139, 
140,  149 
Cream,  ice-,  lactose,  130 
of  pea  soup,  127 


Dairy  products,  chemical  com- 
position of,  138,  148 
composition      and      caloric 
value,  156 
Delafield's  milk  mixture,  131, 132 
Diabetes,  coma  in,  diet  in,  102 
glycosuria  during,  diet  in,  loi 
Joslin's  r6sum6  of  Allen's  treat- 
ment for,  103 
severe  cases,  diet  in,  102 
Diabetic  biscuit,  125 
bread,  125 
diets,  92 

alternate  standard  strict,  94 

95 

comments  on,  99 

for  fast  day,  92 

of  increasing  strength,  96 

standard  strict,  93 

whisky  in,  100 
milk,  125 

Wright's,  analysis  of,  1 26 
patient,  severe,  food  quantity 

required,  106 
recipes,  125 
Diarrhea,  120,  132 
acute,  diet  in,  86 
chronic,  diet  in,  86,  87 
Diarrheal  diseases,  children,  two 
to  five  years,  convalescing  from, 
diet  for,  123 


INDEX 


l6l 


Diet,  anticonstipation,  No.  i,  8i 

No.     2,    82 
constipating,  88 
convalescent,  24 

gastric,  72-74 
five  thousand  calorie,  119 
for  children,  two  to  five  years, 

convalescing  from  diarrheal 

diseases,  123 
for  convalescent  children,  two 

to  five  years,  122 
for  duodenal  feeding,  68 
for  intestinal  conditions,  81 
in  arteriosclerosis,  52 
in  cardiac  diseases,  52 
in   chronic   diarrhea,   food   to 

avoid,  88 
in  diabetes,  92 
in  diarrhea,  acute,  86 

chronic,  86,  87 
in  gastric  disorders,  56 

hyperacidity,  71 

intolerance,  70 
in  gastro-enterostomy,  69 
in  gout,  109 
in  hypertension,  52 
in  indicanuria.  No.  i,  83 

No.  2,  84 
in  intestinal  auto-intoxication, 
No.  I,  83 

No.  2,  84 
in  nephritis,  41 
in  obesity, '115 

caloric  needs,  117 
in    peptic    ulcer,    ambulatory 
cases,  66 
modified,  64 
Sippy's,  62 
von  Leube's,  60 
in  pneumonia,  39 
Lenhartz,  56 
liquid,  27,  28 


Diet,  low-calcium,  120 
milk,  27,  28 

New  York  Hospital,  21,  24 
purin-free,  108 

liquid,  108 

soft,  108 
regular  house,  21 
salt-free,  41-45 
salt-poor.  No.  i,  41 

No.  2,  42 

No.  3,  43 

No.  4,  44 

No.  5,  45 
soft,  27,  28 
typhoid,  30-36 

fluid.  No.  I,  30 
No.  2,  31 

modified  milk  fluid,  33 

soft,  35 

without  milk,  32 
Duodenal  feeding,  67 

diet  for,  68 
tube,  introduction  of,  67 

Eggs,  chemical  composition  of, 

137,  153 

Einhorn,  68 

Eiweissmilch,   129,  132 

Epigastric  pains,  66 

Ewald  test  meal,  77 

Exophthalmic  goiter   with   mal- 
nutrition, 120 

Feeding,  duodenal,  67 

diet  for,  68 
Fermentation,  intestinal,  38 
Fish,   chemical   composition   of, 

136,  137,  148 
composition  and  caloric  value, 

iSS 
purin  bodies  in,  in 


l62 


INDEX 


Five  thousand  calorie  diet,  119 

comments  on,  120 
Fixed    nitrogen,    calcium,    mag- 
nesium diet,  121 
Flatulence,  38 
Flour,  chemical  composition  of, 

138,  r49 
Fluid  diet,  comments  on,  28 
Folin,  108,  113 

Food  values  in  anticonstipation 
diet,  81 
in  convalescent  diet,  26 

children's  diet,  123,  124 
in  gouty  diet,  no 
in  obesity  diet,  116 
in  pneumonia  diet,  39 
in  regular  house  diet,  24 
in  salt-poor  diets,  42-46 
in  soft  diet,  27 
in  typhoid  fluid  diet,  30-36 
soft  diet,  36 
Foods,  carbohydrate  contents  of, 
98 
chemical  composition  of,  134, 

147 
composition  and  caloric  value, 

IS4 
miscellaneous,    chemical    com- 
position of,  138,  145,  146, 

I  S3 
composition      and      caloric 
value,  157 
special,  purin-bodies  in,  113 
vegetable,    chemical    composi- 
tion of,  138-141 
Food-stuffs,  purin-bodies  in,  in 
Foord,  127 
Fresh     vegetables,     composition 

and  caloric  value,  158 
Fruits,  carbohydrate  content  of,  98 
chemical  composition  of,   143, 
151 


Fruits,  composition  and  caloric 

value,  154,  I SS 

Gastric  diagnosis,  78 
diets,  56 
comments  on,  74 
convalescent.  No.  i,  72 
No.  2,  73 
h5rperacidity,  diet  in,  71 
intolerance  diet,  70 
test  meals,  77 
Gastro-enterostomy  diet,  69 
Geyelin,  93,  100 
Geyelin  and  Foster,  158 
Gluten  meal  biscuit,  125 
Gout,  diet  in,  109 
Granat,  126 

Hyperacidity,   gastric,   diet  in, 

71 
Hypertension,  diet  in,  52 

Ice-cream,  lactose,  130 
Indicanuria,  diet  for.  No.  i,  83 

No.  2,  84 
Indigestion,  intestinal,  120 
Intestinal  auto-intoxication  diets, 
comments  on,  85 
No.  I,  83 
No.  2,  84 
conditions,  diets  for,  81 
disturbances,  132 
fermentation,  38 
indigestion,  120 
test  diet,  Schmidt's,  89 
Intolerance,  gastric,  diet  in,  70 

Jane  WAY,  72,  125 

Jellies,  chemical  composition  of, 

144, I S3 

Jelly,  lactose,  128 

Joslin's  rfeum6  of  Allen's  treat- 
ment for  diabetes,  103 


INDEX 


163 


Kakell's  treatment  for  anasarca, 

S3 
Keller's  malt  soup,  130,  132 
ELinnicutt,  F.  P.,  30,  31 

Lamb,  chemical  composition  of, 
135,  147,  148 
composition  and  caloric  value, 

157 
Lambert,  69 
Lactose  ice-cream,  130 

jelly,  128 
Lenhartz  diet,  56 

recapitulation,  59 
Leube's  test  meal,  77 
Liquid  diet,  27,  28 

purin-free  diet,  108 
Locke,  134 
Lockwood,  G.  R.,  60 
Low-calcium  diet,  120 
comments  on,  121 

Magnesium,  fixed  nitrogen,  cal- 
cium diet,  121 

Malnutrition  with  exophthalmic 
goiter,  120 

Malt  soup,  Keller's,  130,  132 

Martin's  milk,  131 

Meals,  chemical  composition  of, 

138,  149 
Meat,   chemical  composition  of, 
134-136,  147,  148 
composition  and  caloric  value, 

IS4,  157 
purin-bodies  in,  112 
Men,  average  weights  for,  19, 133 
Milk,  diabetic,  125 

Wright's,  analysis  of,  126 
diet,  27,  28 

comments  on,  28 
Martin's,  131 
mixture,  Delafield's,  131 


Milk,  protein,  129,  132 
Wright's  diabetic,  1 26 
Miscellaneous     foods,     chemical 
composition  of,  138,  145, 
146,  153 
composition      and      caloric 
value,  157 
recipes,  127 
comments  on,  131 
Mixture,  Delafield's  milk,  131, 132 
Mosenthal,  47 

Mutton,  chemical  composition  of, 
135,  147,  148 

Nausea,  38,  131 

Nephritic  diets,  41-49 

test  day,  Schlayer's,  directions 
for,  47 

Nephritis,  chronic  hypertensive, 
urinary  findings  in,  49 
diet  in,  41 

New  York  Hospital  diet,  21,  24 

Nitrate  of  silver,  61 

Nitrogen,    fixed,    calcium,    mag- 
nesium diet,  121 

Nuts,  carbohydrate  content  of,  99 
chemical  composition  of,  145, 

153 
composition        and        caloric 
value,  154 

Obesity  diets,  115 
comments  on,  116 

Pastry,  chemical  composition  of^ 

139,  140,  141,  152 
Pea  soup,  cream  of,  127 
Peptic  ulcer,  ambulatory  cases, 
diet  for,  66 
modified  diet  for,  64 
Sippy's  treatment  for,  62 
von  Leube's  treatment  for,  60 


164 


INDEX 


Pneumonia,  diet  in,  39 

comments  on,  39,  40 
Pork,   chemical   composition   of, 

135,  147,  148 
composition        and        caloric 

value,  157 
Potato  gluten  biscuit,  125 
Poultry,  chemical  composition  of, 

136,  147,  148 
composition  and  caloric  value, 

154,  157 
Preserves,  chemical  composition 

of,  144,  153 
Protein  milk,  129,  132 
Protopuff  No.  I,  125 
Puddings,  chemical    composition 

of,  141,  152 
Pure  gluten  biscuit,  125 
Purin -bodies  in  food-stuffs,  in 
Purin-free  articles  of  diet,  no 
diets,  108 
comments  on,  113 
liquid,  108 
soft,  108 

Raised  bran  biscuits,  127 
Recipes,  diabetic,  125 
miscellaneous,  127 
Regular  house  diet,  21 

comments  on,  27 
Reubner,  19 
Richter,  115 
Riegel's  test  meal,  77 

SALT-free  diets,  41-49 
Salt-poor  diets,  41-49 
comments  on,  50 
Sausage,  chemical  composition  of, 

136 
Schaefer,  37 
Schlayer's    nephritic    test    day, 

directions  for,  47 


Schmidt's  intestinal  test  diet,  89 
comments  on,  91 
modified,  90 
Serial  test  meal,  77,  80 
Silver,  nitrate  of,  61 
Siphon  Vichy,  60 
Sippy's  treatment  for  peptic  ulcer, 

62 
Soft  diet,  27,  28 

comments  on,  27,  28 
purin-free  diet,  108 
Soja-bean  meal  biscuit,  125 
Soup,  black  bean,  128 
chemical  composition  of,  145, 

153 

cream  of  pea,  127 

malt,  Keller's,  130,  132 
Starches,    chemical    composition 

of,  141 
Sugars,  chemical  composition  of, 

141, 153 

Test   day,  Schlayer's  nephritic, 
directions  for,  47 
diet,  intestinal,  Schmidt's,  89 
meal,  gastric,  77 
chemistry  of,  79 
comments  on,  78 
Ewald's,  77 
Leube's,  77 
Riegel's,  77 
serial,  77,  80 
Tibbies,  116 

Tube  duodenal,  introduction  of,  67 
Tympanites,  38 
Typhoid  diets,  30-36 
comments  on,  36 
fluid.  No.  I,  30 

No.  2,  31 
modified  milk  fluid,  33 
soft,  35 
without  milk,  32 


INDEX 


165 


Ulcer,  peptic,  ambulatory  cases, 
diet  for,  66 
modified  diet  for,  64 
Sippy's  treatment  for,  62 
von  Leube's  treatment  for, 
60 
Urinary     findings     in     case     of 
chronic  hypertensive  nephritis, 
49 


Vanderbh-t's  dinic  diet,  81,  108, 

no 
Veal,   chemical   composition   of, 

135,  147,  148 
composition  and  caloric  value, 

157 
Vegetable  foods,  chemical  com- 
position of,  138-141 
Vegetables,  canned,  composition 
and  caloric  value,  156 
carbohydrate  content  of,  98 


Vegetables,  chemical  composition 
of,  141,  142,  143,  149 

fresh,  composition  and  caloric 
value,  158 

purin-bodies  in,  112 
Vogel,  121 
Vomiting,  38,  131 
von  Leube's  treatment  for  peptic 

ulcer,  60 
von  Noorden,  20,  109,  117 

Walker,  H.  J.,  hi 
Water,  Carlsbad,  61 
Weights,  average,  for  men  and 

women,  19,  133 
Whisky  in  diabetes,  100 
Widal,  so 
Wolf,  C.  G.  L.,  121 
Women,  average  weights  for,  19, 

133 
Wright,  125 
diabetic  milk  of,  analysis,  126 


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